Expandable intervertebral implants and methods of installation thereof

ABSTRACT

Embodiments herein are generally directed to expandable spinal implants, systems, apparatuses, and components thereof that can be used in spinal fusion and/or stabilization procedures, as well as methods of installation. The expandable spinal implants may be configured for lateral insertion.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a continuation application of U.S. patentapplication Ser. No. 16/010,896, filed on Jun. 18, 2018, which is acontinuation application of U.S. patent application Ser. No. 15/729,211,filed on Oct. 10, 2017 (published as U.S. Patent Publication No. US2018-0085229), which is a continuation application of U.S. patentapplication Ser. No. 14/712,434, filed May 14, 2015, now issued as U.S.Pat. No. 9,814,602. The disclosures of all of which are beingincorporated herein by reference in their entirety.

FIELD OF THE INVENTION

The present disclosure relates to expandable intervertebral devices andmethods used to install these devices.

BACKGROUND OF THE INVENTION

Many types of spinal irregularities can cause pain, limit range ofmotion, or injure the nervous system within the spinal column. Theseirregularities can result from, without limitation, trauma, tumor, discdegeneration, and disease. One example of a spinal irregularity that mayresult from disc degeneration is spinal stenosis, the narrowing of aspinal canal, which can result in the compression of spinal nerves suchas the spinal cord or cauda equina. In turn, the nerve compression canresult in pain, numbness, or weakness. Other examples of conditions thatcan result from disc degeneration are osteoarthritis and discherniation.

Often, these irregularities can be treated by performing a discectomyand/or immobilizing a portion of the spine. For example, treatment caninclude a surgical procedure that involves removal and replacement of anaffected intervertebral disc with a prosthesis and the subsequent fusionof adjacent vertebrae. The prosthesis, such as an interbody cage orspacer, may be used either alone or in combination with one or moreadditional devices such as rods, screws, and/or plates.

SUMMARY OF THE INVENTION

Some embodiments herein are directed to an expandable spinal implantthat can include a stationary base member comprising an elongate slot,the elongate slot having a longitudinal axis parallel to a longitudinalaxis of the primary base member; a movable base member comprising anangled slot, the angled slot having a longitudinal axis that intersectsa longitudinal axis of the movable base member; at least one guidemember comprising a first end configured to be reversibly receivedwithin the primary base member and a second end configured to bereceived within the movable base member; and an actuator comprising afirst arm configured to slideably engage the elongate slot and a secondarm configured to slideably engage the angled slot.

Other embodiments herein are directed to an expandable spinal implantthat can include a primary base member comprising an elongate slot, theelongate slot comprising an axis that is parallel to at least a portionof an inner side wall of the primary base member; a movable base membercomprising an angled slot, the angled slot comprising an axis thatintersects an inner side wall of the movable base member; at least oneguide member comprising a first end configured to be reversibly receivedwithin the movable base member and a second end configured to bereceived within the stationary base member; and an actuator comprising afirst arm configured to slideably engage the elongate slot and a secondarm configured to slideably engage the angled slot.

Yet other embodiments herein are directed to an expandable spinalimplant that can include a primary base member comprising a leading end,a trailing end, and a length therebetween, and further comprising anelongate slot extending at least partially along the length thereof,wherein the elongate slot extends parallel to the length of the primarybase member; a movable base member comprising a leading end, a trailingend, and a length therebetween, and further comprising an angled slotextending at least partially along the length thereof, wherein theangled slot intersects at least one side surface of the movable basemember; at least one guide member comprising a first end configured tobe reversibly received within the movable base member and a second endconfigured to be received within the stationary base member; and anactuator comprising a first arm configured to slideably engage theelongate slot and a second arm configured to slideably engage the angledslot.

Some embodiments herein are directed to an expandable spinal implantthat can include an elongate body comprising a leading end and atrailing end; an actuator housed within the elongate body; atranslatable connector configured to engage the actuator and translaterelative thereto; a leading arm pivotably coupled to the connector andslideably coupled to the leading end of the elongate body; and atrailing arm pivotably coupled to the leading arm and slideably coupledto the trailing end of the elongate body.

Other embodiments herein are directed to an expandable spinal implantthat can include an elongate body comprising a first end and a secondend; a first arm pivotably and translationally coupled to the elongatebody at the first end; and a second arm pivotably and translationallycoupled to the elongate body at the second end; wherein the first andsecond arms are hingedly coupled to each other.

Yet other embodiments herein are directed to an expandable spinalimplant that can include an elongate body comprising a first end and asecond end; a first arm having a lateral end and a medial end, whereinthe lateral end of the first arm is pivotably and translationallycoupled to the first end of the elongate body; and a second arm having alateral end and a medial end, wherein the lateral end of the second armis pivotably and translationally coupled to the second end of theelongate body; wherein the medial ends of the first and second arms arehingedly coupled to each other; and wherein the medial ends of the firstand second arms are configured to reversibly pivot towards and away fromthe elongate body.

Some embodiments herein are directed to an elongate body having a firstend and a second end; a first arm comprising a lateral end and a medialend, wherein the medial end of the first arm is coupled with the firstend of the elongate body; and a second arm comprising a lateral end anda medial end, wherein the medial end of the second arm is coupled withthe second end of the elongate body.

Other embodiments herein are directed to an expandable spinal implantthat can include a first elongate body having a leading end and atrailing end; a second elongate body having a leading end and a trailingend; a first arm comprising a proximal end and a distal end, wherein thedistal end is pivotably coupled to the first elongate body; a second armcomprising a proximal end and a distal end, wherein the distal end ispivotably coupled to the second elongate body and the proximal end isrotatably engaged with the first arm; and a linearly-translatableactuator pivotably coupled to the proximal ends of the first and secondarms.

Still other embodiments herein are directed to an expandable spinalimplant that can include a first elongate body comprising a leading endand a trailing end; a second elongate body comprising a leading end anda trailing end; and a first expansion assembly, comprising a first rampmember configured to slideably engage the first elongate body, a secondramp member configured to slideably engage the second elongate body, anda wedge member configured to slideably engage the first and second rampmembers.

Further areas of applicability of the present disclosure will becomeapparent from the detailed description provided hereinafter. It shouldbe understood that the detailed description and specific examples, whileindicating certain embodiments, are intended for purposes ofillustration only and are not intended to limit the scope of thedisclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure will become more fully understood from thedetailed description and the accompanying drawings, wherein:

FIG. 1 illustrates a perspective view of one embodiment of an expandablespinal implant described herein;

FIG. 2A illustrates a perspective view of one embodiment of a primarybase member described herein;

FIGS. 2B-D illustrate cross-sectional views of one embodiment of aprimary base member described herein;

FIG. 2E illustrates a perspective view of one embodiment of a primarybase member described herein;

FIG. 3A illustrates a perspective view of one embodiment of a movablebase member described herein;

FIGS. 3B-C illustrate cross-sectional views of one embodiment of amovable base member described herein;

FIG. 3D illustrates a perspective view of one embodiment of a movablebase member described herein;

FIG. 4A illustrates a perspective view of one embodiment of anexpandable spinal implant and a driver as described herein;

FIG. 4B illustrates a perspective view of one embodiment of a driverdescribed herein;

FIGS. 4C-E illustrate perspective views of one embodiment of anexpandable spinal implant and a driver as described herein;

FIGS. 4F-G illustrate cross sectional views of one embodiment of anexpandable spinal implant and a driver as described herein;

FIGS. 5A-B illustrate perspective views of one embodiment of anexpandable spinal implant described herein;

FIGS. 6A-D illustrate schematic views of one embodiment of an expandablespinal implant described herein;

FIG. 6E illustrates a schematic view of one embodiment of a wedge memberdescribed herein; and

FIGS. 7A-C illustrate perspective views of one embodiment of anexpandable spinal implant described herein

FIGS. 8A-8D illustrate another embodiment of an expandable spinalimplant.

DETAILED DESCRIPTION

In a spinal fusion procedure, the intervertebral disc space can beaccessed via various approaches (e.g., anterior, posterior,transforaminal, and/or lateral). In a lateral procedure, a prosthesismay be inserted through an incision on a patient's side; advantageously,this type of approach may generally avoid muscles and nerves that mayotherwise be encountered in an anterior, posterior, and/ortransforaminal approach. Disclosed herein are expandable spinal implantsthat can be configured for use in lateral lumbar interbody fusion (LLIF)procedures, and that may be referred to as expandable lateral spinalimplants. For example, the expandable spinal implants may each have alength (e.g., as measured between the leading and trailing ends) that isabout 100-300% greater than a width thereof (e.g., as measured in theanterior-posterior direction). The expandable implants may also eachhave a length that is configured to laterally span a vertebral endplate.For example, the expandable spinal implants may each have a length inthe range of from about 40 mm to about 60 mm. In some embodiments, theexpandable implant may have a constant (e.g., static and/orunexpandable) length. The expandable spinal implants described hereinmay have a variable width and may be configured to collapse to a smallerwidth prior to insertion and/or expand to a larger width afterinsertion. For example, some spinal implants described herein may have acollapsed width in the range of from about 15 mm to about 30 mm, and anexpanded width in the range of from about 20 mm to about 35 mm. Otherspinal implants described herein may have a collapsed width in the rangeof from about 10 mm to about 15 mm, and an expanded width in the rangeof from about 25 mm to about 30 mm. Accordingly, these spinal implantsmay be configured for use in minimally-invasive surgery (MIS). Forexample, they may be inserted through a relatively small incision (e.g.,10-30% narrower), reducing trauma to the patient. Additionally, thesespinal implants may be inserted laterally in the far anterior side ofthe intervertebral space, thereby minimizing interference with thelumbar plexus. Conversely, the expandable spinal implants describedherein may be configured to expand to a width greater than that of otherimplants in the art (e.g., 15-40% greater), without requiring a largerincision. Accordingly, the expandable spinal implants of the presentdisclosure may be configured to more evenly distribute the vertebralload, increase surface area contact with the vertebral endplates, engagebone adjacent the apophyseal ring, reduce or inhibit cage subsidence,and/or promote increased fusion by being configured to receive a greateramount of biomaterials, without increasing trauma to the patient.

Components of all of the systems and devices disclosed herein can bemade of materials known to those skilled in the art, including metals(e.g., titanium), metal alloys (e.g., stainless steel, titanium alloys,and/or cobalt-chromium alloys), ceramics, polymers (e.g., poly etherether ketone (PEEK), polyphenylene sulfone (PPSU), polysulfone (PSU),polycarbonate (PC), polyetherimide (PEI), polypropylene (PP),polyacetals, or mixtures or co-polymers thereof), allograft, and/orcombinations thereof. In some embodiments, the systems and devices mayinclude radiolucent and/or radiopaque materials. In other embodiments,one or more components may be coated with a bone growth-enhancingmaterial, such as hydroxyapatite. The components can also be machinedand/or manufactured using techniques known to those skilled in the art.For example, polymeric components may be injection-molded orblow-molded. Additionally, the devices disclosed herein may be usedtogether with materials that encourage bone growth, such as bone graftmaterial, demineralized bone matrix, bone chips, and/or bonemorphogenetic proteins. In some embodiments, these materials mayadvantageously be packed into hollow areas of the devices describedherein.

As described herein, the spinal implants of the present disclosure maybe configured for placement between two adjacent vertebrae, for example,as part of a spinal fusion procedure. These spinal implants may bereferred to as, without limitation, interbody spacers, interbody fusiondevices, interbody cages, and/or intervertebral cages. Each of thespinal implants described herein may include superior and/or inferiorsurfaces that are configured to engage and/or contact a vertebralendplate or other vertebral surface. In some embodiments, the superiorand/or inferior surfaces may be convex, corresponding to the topographyof the endplates. Additionally, the superior and/or inferior surfaces ofeach of the spinal implants described herein may include one or moretexturizing members. Examples of such texturizing members include, butare not limited to, projections, bumps, teeth, grooves, peaks, spikes,and/or knurling. These texturizing features may advantageously enhancethe interaction or fiction, and/or reduce movement, between the implantand the vertebrae. Those skilled in the art may appreciate thatdirectional terms such as “anterior,” “posterior,” “superior,”“inferior,” “top,” and “bottom,” and the like may be used herein fordescriptive purposes and do not limit the orientation(s) in which thedevices may be used. For example, those skilled in the art mayappreciate that, in use, a “superior” surface may be installed adjacentan inferior vertebra, and vice versa. Accordingly, a feature describedas being on top may actually be oriented towards the bottom afterinstallation.

Turning now to FIGS. 1-4G, some embodiments herein are directed to anexpandable spinal implant 100 that can include a first (e.g., primaryand/or stationary) base member 2, a second (e.g., movable) base member4, at least one guide member 6, and an actuator 8. The implant 100 mayinclude a leading end 3 and a trailing end 5. As described furtherherein, the movable base member 4 may be configured to move (e.g.,translate) relative to the primary base member 2, or vice versa. Theexpandable spinal implant 100 may advantageously be configured totransition between an expanded configuration and a collapsedconfiguration, wherein the implant 100 has a width, as measured betweenan outer side surface of the primary base member 2 and an outer sidesurface of the movable base member 4, that is greater in the expandedconfiguration than in the collapsed configuration. In some embodiments,the expandable spinal implant 100 may have a collapsed width in therange of from about 15 mm to about 30 mm, and an expanded width in therange of from about 20 mm to about 35 mm. The primary and movable basemembers 2, 4 may define an expandable window 104 therebetween. Theexpandable window 104 may be configured to receive a fusion-enhancingmaterial or other biomaterial, as described herein.

As illustrated in FIG. 2A, the primary base member 2 can include aleading end 14, a trailing end 16, and a side wall 18 therebetween. Theprimary base member 2 may have a length as measured between the leadingend 14 and the trailing end 16. Although not limited to any particularorientation, in some embodiments the side wall 18 may be configured tobe oriented anteriorly in a patient and may thus be referred to as ananterior side wall. The primary base member 2 can also include asuperior surface 20, an inferior surface 22, an inner side surface 24,and an outer side surface 26. In some embodiments, the outer sidesurface 26 may be convex, as viewed from the superior and/or inferiorsurfaces 20, 22. The superior and inferior surfaces 20, 22 may beconvex, as viewed from the outer side surface 26, leading end 14, and/ortrailing end 16. As described herein, the superior and/or inferiorsurfaces 20, 22 may include a plurality of texturizing members.

As illustrated in FIGS. 2B-C, the primary base member 2 can include anelongate slot 10. As illustrated in FIG. 2B, the elongate slot 10 caninclude a longitudinal axis 12 and can extend in a straight line and/orat least partially along a length of the primary base member 2.Accordingly, the longitudinal axis 12 of the elongate slot 10 may beparallel to the length and/or a longitudinal axis 13 of the primary basemember 2, as illustrated in FIG. 2B. The longitudinal axis 12 may beparallel to at least a portion of the inner side surface 24, asillustrated in FIG. 2B. As illustrated in FIG. 2A, the elongate slot 10can include an opening 28 that extends along the inner side surface 24of the primary base member 2. The opening 28 may also extend at leastpartially along the trailing end 16 of the primary base member 2, asillustrated in FIG. 2A. As illustrated in FIG. 2C, the elongate slot 10can include a main passageway 30 and a supplemental passageway, thesupplemental passageway including first and second corridors 32, 34. Thefirst and second corridors 32, 34 may each extend in opposite directionsat a 90 degree angle away from the main passageway 30. Accordingly, theelongate slot 10 can include a T-shaped transverse cross-section.

As illustrated in FIG. 2C, the leading end 14 may be tapered. Forexample, the leading end 14 can include a tapered height (e.g., asmeasured between the superior surface 20 and the inferior surface 22)and/or a tapered width (e.g., as measured between the inner side surface24 and the outer side surface 26). In use, the tapered leading end 14may advantageously be configured to distract tissue during insertion. Asillustrated in FIGS. 2A and 2C, the leading end 14 can include atool-engaging recess 36. The tool-engaging recess 36 can passlongitudinally through the leading end 14, for example, along an axisparallel to the longitudinal axis 12 of the elongate slot 10. Asillustrated in FIGS. 2B and 2D, the axis of the tool-engaging recess maybe displaced, e.g., posteriorly, relative to the longitudinal axis 12 ofthe elongate slot 10. As illustrated in FIGS. 2B and 2D, thetool-engaging recess 36 can include an inner opening 38, an outeropening 40, and a narrowed passageway 42 therebetween. In someembodiments, the narrowed passageway 42 can include a non-circulartransverse cross-section. For example, as illustrated in FIG. 2E, thenarrowed passageway 42 can include an axially-extending notch 44. Asdescribed further herein, the notch 44 may advantageously be keyed toengage a driver or other tool. As illustrated in FIG. 2E, the inner sidesurface 24 can include at least one receptacle 46. The receptacle 46 canbe configured to receive at least a portion of the guide member 6therein and can be, for example, cylindrical. In some embodiments, theprimary base member 2 can include a plurality of receptacles configuredto engage a plurality of guide members. For example, the primary basemember 2 can include 2, 4, 6, 8, 10, or more receptacles. In someembodiments, the primary base member 2 can include at least one pair ofvertically-aligned receptacles, wherein a first receptacle is positionedabove the elongate slot 10 and a second receptacle is positioned belowthe elongate slot 10, as illustrated, for example, in FIG. 2E.

As illustrated in FIG. 3A, the movable base member 4 can include aleading end 48, a trailing end 50, and a side wall 52 therebetween. Themovable base member 4 may include a length as measured between theleading end 48 and the trailing end 50. Although not limited to anyparticular orientation, in some embodiments the movable base member 4may be configured to be oriented posteriorly in a patient, relative tothe primary base member 2, and the side wall 52 may thus be referred toas a posterior side wall. In some embodiments, the movable base member 4may have a maximum height that is less than a maximum height of theprimary base member 2, so as to match the natural lordosis of a spine.In these embodiments, the expandable spinal implant 100 may bewedge-shaped. In other embodiments, the expandable spinal implant 100may have a constant height. The movable base member 4 can also include asuperior surface 54, an inferior surface 56, an outer side surface 58,and, as illustrated in FIG. 3D, an inner side surface 60. In someembodiments, the outer side surface 58 may include a section that isstraight or generally straight (e.g., non-curved), as viewed from thesuperior and/or inferior surfaces 54, 56. The superior and inferiorsurfaces 54, 56 may be convex, as viewed from the outer side surface 58,leading end 48, and/or trailing end 50. As described herein, thesuperior and/or inferior surfaces 54, 56 may include a plurality oftexturizing members.

The movable base member 4 can include an elongate slot 62, asillustrated in FIGS. 3A-B. The elongate slot 62 may extend at leastpartially along the length of the movable base member 4 and mayintersect at least one side surface thereof. The elongate slot 62 caninclude a longitudinal axis 64, which may intersect the inner and/orouter side surfaces 58, 60. As illustrated in FIG. 3B, the longitudinalaxis 64 may intersect the outer side surface 58 at the trailing end 50and/or may intersect the inner side surface 60 at the leading end 48.Accordingly, the longitudinal axis 64 of the elongate slot 62 may beangled relative to (e.g., may intersect) a longitudinal axis 64 of themovable base member 4, as illustrated in FIG. 3B. Furthermore, in someembodiments, the elongate slot 62 may be referred to as an angled slot.As illustrated in FIG. 3D, the elongate slot 62 can include an opening66 that extends along the inner side surface 60 of the movable basemember 4. The opening 66 may also extend at least partially along thetrailing end 50, as illustrated in FIG. 3D. As illustrated in FIG. 3C,the elongate slot 62 can include a main passageway 68 and a supplementalpassageway, the supplemental passageway including first and secondcorridors 70, 72. The first and second corridors 70, 72 may each extendin opposite directions at a 90 degree angle away from the mainpassageway 69. Accordingly, the elongate slot 62 can include a T-shapedtransverse cross-section.

As illustrated in FIG. 3D, the leading end 48 may be tapered. Forexample, the leading end 48 can include a tapered height (e.g., asmeasured between the superior surface 54 and the inferior surface 56)and/or a tapered width (e.g., as measured between the inner side surface60 and the outer side surface 58). In use, the tapered leading end 48,alone or in conjunction with the leading end 14 of the primary basemember 2, may be used to distract tissue during insertion. Asillustrated in FIG. 3A, the trailing end 50 can include a channel 74passing longitudinally therethrough. The channel 74 may be configured toreceive a tool, such as a driver, therethrough. In some embodiments, thechannel 74 may include a rounded or curved inner surface; in otherembodiments, it may include an angled inner surface. In someembodiments, the channel 74 may include a threaded interior. The channel74 may not be fully enclosed and may be U-shaped. In some embodiments,the channel 74 may have an opening that extends at least partially alongthe inner side surface 60. In an assembled and collapsed or closedconfiguration, the channel 74 of the trailing end 50 of the movable basemember 4 may be configured to be coaxial with the tool-engaging recess36 of the leading end 14 of the primary base member 2. As illustrated inFIG. 3D, the inner side surface 60 can include at least one receptacle76. The receptacle 76 can be configured to receive at least a portion ofthe guide member 6 therein, and can be, for example, cylindrical. Insome embodiments, the movable base member 4 can include a plurality ofreceptacles configured to engage a plurality of guide members. Forexample, the movable base member 4 can include 2, 4, 6, 8, 10, or morereceptacles. In some embodiments, the movable base member 4 can includeat least one pair of vertically-aligned receptacles, wherein a firstreceptacle is positioned above the elongate slot 62 and a secondreceptacle is positioned below the elongate slot 62, as illustrated inFIG. 3D.

As illustrated in FIG. 1, the guide member 6 may be a cylindrical pin.The guide member 6 can include a first end 78 configured to be coupledwith the primary base member 2 and a second end 80 configured to becoupled with the movable base member 4. The guide member 6 may beconfigured to be reversibly or irreversibly coupled with the primaryand/or movable base members 2, 4. In some embodiments, the guide member6 may be integral to the primary and/or movable base members 2, 4. Theguide member 6 may be configured to be received within any of thereceptacles (e.g., receptacle 46 and/or 76) of the primary and/ormovable base members 2, 4. The guide member 6 may be configured to besimultaneously received within the primary and movable base members 2, 4when the expandable spinal implant 100 is assembled (in an expandedand/or contracted configuration). The guide member 6 may thus include alength, as measured between the first and second ends 78, 80, which isnot greater than a width of the expandable spinal implant 100, asmeasured from the outer side surface 26 to the outer side surface 58.Additionally, the guide member 6 may include a diameter that is notgreater than a diameter of the receptacles 46 and/or 76. Furthermore,the guide member 6 may be configured to translate within the receptacles46 and/or 76. As illustrated in FIG. 1, the expandable spinal implant100 may include a plurality of guide members 6, such as at least onepair thereof. For example, the expandable spinal implant 100 can include2, 4, 6, 8, 10, or more guide members 6.

As illustrated in FIG. 1, the actuator 8 can include a first arm 82 anda second arm 84, each extending from a central member 98. The first andsecond arms 82, 84 may extend in opposite directions. The first arm 82can be configured to slideably engage and/or be received within theelongate slot 10 and the second arm 84 can be configured to slideablyengage and/or be received within the elongate (e.g., angled) slot 62.Those skilled in the art may appreciate that each of the first andsecond arms 82, 84 can include a T-shaped end configured to be receivedwithin the T-shaped elongate slots 10, 62. The first arm 82 can includea first projection 86, the first projection 86 including an upper prong90 and a lower prong 92, wherein each of the upper and lower prongs 90,92 extend in opposite directions at a 90 degree angle from the first arm82. The upper and lower prongs 90, 92 may be coaxial. The first arm 82and first projection 86 may be coplanar. The second arm 84 can include asecond projection 88, the second projection 88 including an upper prong94 and a lower prong 96, wherein each of the upper and lower prongs 94,96 extend in opposite directions at a 90 degree angle away from thesecond arm 84. The upper and lower prongs 94, 96 may be coaxial. Thesecond arm 84 and the second projection 88 may be coplanar. The firstand/or second projections 86, 88 may each have a height that is notgreater than a height of the supplemental passageways of the primary andmovable base members 2, 4, respectively. The actuator 8 may have a width(e.g., as measured from the first projection 86 to the second projection88) that is not greater than a width of the expandable implant 100. Thecentral member 98 can include a threaded hole 102 extendingtherethrough. The threaded hole 102 may include an axis that isperpendicular to an axis of the first arm 82, second arm 84, firstprojection 86, and/or second projection 88. When in an assembledconfiguration (e.g., when the first and second projections 86, 88 areslideably received within the elongate and angled slots 10, 62), eitherexpanded or collapsed, the threaded hole 102 may be configured to becoaxial with the tool-engaging recess 36 of the primary base member 2.In some embodiments, the central member 98 may include a generallycylindrical or rounded exterior. The central member 98 may be configuredto be received and/or nested within the channel 74 of the movable basemember 4. The central member 98 may have an outer dimension (e.g.,height, width, and/or diameter) that is less than that of the channel74.

When the expandable spinal implant 100 is assembled, for example, asillustrated in FIGS. 4A-F, the primary and movable base members 2, 4 maybe oriented or positioned next to each other with the leading ends 14,48 at one end (e.g., at the leading end 3 of the implant 100), thetrailing ends 16, 50 at another end (e.g., at the trailing end 5 of theimplant 100), and the inner side surfaces 24, 60 facing each other.Expandable window 104 may be defined between the primary and movablebase members 2, 4. In use, the expandable window 104 may be configuredto receive a biomaterial such as bone graft material, demineralized bonematrix, bone chips, and/or bone morphogenetic proteins. Those skilled inthe art may appreciate that, in an assembled configuration, the distancebetween the elongate slot 10 and the angled slot 62 may decrease towardsthe leading ends 14, 48. Additionally, the actuator 8 may be disposedand/or located between the primary and movable base members, 2, 4, withthe first projection 86 of the actuator slideably disposed within theelongate slot 10 and the second projection 88 of the actuator 8slideably disposed within angled slot 62. At least a portion of thefirst end 78 of the guide member 6 may be slideably disposed or locatedwithin the receptacle 46 of the primary base member 2 and at least aportion of the second end 80 may be slideably disposed or located withinthe receptacle 76 of the movable base member 4.

As described herein, when assembled, the expandable spinal implant 100may be configured to reversibly transition between an expandedconfiguration and a collapsed configuration, wherein the width of theimplant 100 is greater in the expanded configuration than in thecollapsed configuration. In the collapsed configuration, for example, asillustrated in FIG. 4A, the actuator 8 may be disposed and/or located atthe trailing end 5 of the implant 100. In use, the expandable spinalimplant 100 may expand (e.g., may transition from the collapsedconfiguration to the expanded configuration) by actuating, driving,pushing, pulling, sliding, translating, and/or moving the actuator 8laterally along the elongate and angled slots 10, 62 towards the leadingend 3 of the implant 100, as illustrated in FIGS. 4F-G. Those skilled inthe art may appreciate that because the distance between the elongateslot 10 and the angled slot 62 narrows, the second arm 84 of theactuator 8 may push the movable base member 4 outwards (e.g.,posteriorly and/or away from the primary base member 2) as it travelstowards the leading end 3, thereby expanding the implant 100. The guidemember(s) 6 may assist, encourage, facilitate, and/or promote linearmotion of the movable base member 4 away from the primary base member 2.

As illustrated in FIG. 4A, in some embodiments, a driver 106 may be usedto actuate, push, pull, slide, translate, and/or move the actuator 8 tothereby expand and/or collapse the implant 100. As illustrated in FIG.4B, the driver 106 may include an inner shaft 108 disposed within anouter shaft 110. The inner and outer shafts 108, 110 may be coaxial(e.g., may share a common longitudinal axis, such as longitudinal axis130). The outer shaft 110 and the inner shaft 108 may be configured torotate relative to (e.g., independently of) each other. The outer shaft110 can include an elongate rod portion 114 extending from a handleportion 116. The outer shaft 110 may also include a distal tip 132 at adistal-most end of the elongate rod portion 114. The elongate rodportion 114 can include a distal threaded section 118, which may beconfigured to engage the threaded hole 102 of the actuator 8. Theelongate rod portion 114 may also include a proximal non-threadedsection 120. The elongate rod portion 114 may a constant outer diameter.In some embodiments, the elongate rod portion 114 may be configured tonest and/or be received within the channel 74 of the movable base member4. Accordingly, in some embodiments, the elongate rod portion 114 or asection thereof (e.g., non-threaded section 120) may include an outerdiameter that is less than a height of the channel 74. The handle 116may include a gripping surface, and may, for example, include a roundedor angled exterior. The handle 116 may be configured to be grasped by auser.

As illustrated in FIG. 4A, the outer shaft 110 can include a cylindricalcannula 112 extending along a longitudinal axis therethrough. The innershaft 108 may be located within the cylindrical cannula 112. The innershaft 108 may be configured to rotate within the cannula 112. The innershaft 108 can include a proximal knob 122 that is configured to extendproximally from the outer shaft 110. The proximal knob 122 may include agripping surface and/or may be configured to be grasped by a user. Theinner shaft 108 can also include an elongate rod portion 124 extendingfrom the knob 122. The inner shaft 108 can also include a key member 126at a distal end 128 of the elongate rod portion 124. The key member 126can include a protrusion that extends at an angle away from thelongitudinal axis 130. For example, the key member 126 may extendperpendicularly to the longitudinal axis 130. In other embodiments, thekey member 126 can include a hook or a bend at the distal end 128 of theelongate rod portion 124. The key member 126 may be keyed to fit withinthe notch 44 of the primary base member 2. Accordingly, at least aportion of the distal end 128, including key member 126, may be sizedand/or configured to fit within and/or pass through the tool-engagingrecess 36 of the primary base member 2. In some embodiments, the driver106 may also include one or more locking members to prevent or inhibittranslational motion of the inner and/or outer shafts 108, 110 relativeto each other. The driver 106 may also include one or more seals,washers, and/or o-rings between the inner and outer shafts 108, 110.

Embodiments herein are also directed to methods of installing theexpandable spinal implant 100. These methods can include providing theimplant 100 in the closed or collapsed configuration as describedherein, where the implant 100 has a closed or collapsed width. Thesemethods can also include expanding the implant 100 to an expanded widthby translating the actuator 8 from the trailing end 5 of the implant 100towards the leading end 3 of the implant 100 to thereby separate (e.g.,increase the distance between) the movable base member 4 from theprimary base member 2.

In some embodiments, the step of providing the expandable spinal implant100 in the closed or collapsed configuration can include inserting theimplant 100 into a selected location, such as a cavity between twovertebral bodies created by a discectomy or other procedure. The implant100 can be inserted into the cavity using a variety of approaches, suchas anteriorly, posteriorly, transforaminally, or laterally. In someembodiments, the implant 100 may advantageously be configured to beinserted into an intervertebral space using a lateral procedure. Thoseskilled in the art may appreciate that, in some embodiments, when in theclosed or collapsed configuration, the expandable spinal implant 100 mayhave a width that is about 10-30% less than the width in the expandedconfiguration. In some embodiments, the closed or collapsed width of theimplant 100 may be about 15-25% less than the expanded width.Advantageously, the implant 100 may be inserted through a smaller,less-invasive opening that may result in reduced trauma to muscles,nerves, or other tissue. When used in a lateral procedure (e.g., laterallumbar interbody fusion), the implant 100 may be inserted laterally inthe far anterior side of the intervertebral space, for example, asillustrated in FIG. 4C. This technique can advantageously reduce orminimize interaction with the posteriorly-located lumbar plexus.

In some embodiments, the driver 106 can be used to translate theactuator 8 from the trailing end to the leading end of the implant 100.This step can include inserting the driver 106 into the implant 100through the trailing end thereof, as illustrated in FIGS. 4C-D. Thisstep can also include coupling the distal threaded section 118 of thedriver 106 with the threaded hole 102 of the actuator 8. For example,the distal threaded section 118 can be threaded into the threaded hole102. In some embodiments, the threading may be accomplished by applyinga rotational force to the handle 116 while engaging the knob 122 toprevent or inhibit rotation of the inner shaft 108. This step can alsoinclude inserting at least a portion of the distal end 128 into thetool-engaging recess 36, as illustrated in FIG. 4D, until the key member126 is seated within the outer opening 40 of the tool-engaging recess 36and the distal tip 132 is seated within the inner opening 38 and abutsthe narrowed passageway 42.

The driver 106 can then be locked, anchored, and/or secured within theimplant 100. As illustrated in FIGS. 4D-E, this step can includerotating the inner shaft 108 by an angle greater than 0 degrees and lessthan 360 degrees (e.g., by an angle between 90 degrees and 270 degrees)until the key member 126 is out of alignment with the notch 44. Thisstep may be accomplished by applying a rotational force to the knob 122while engaging the handle 116 to prevent or inhibit rotation of theouter shaft 110. As illustrated in FIG. 4F, those skilled in the art mayappreciate that, when locked, the key member 126 and/or the distal tip132 may prevent or inhibit translational movement of the driver 106relative to the implant 100.

The outer shaft 110 can then be rotated. The distal threaded section 118can engage the threaded hole 102 of the actuator 8 to actuate, drive,push, pull, slide, translate, and/or move the actuator 8 laterally alongthe elongate and angled slots 10, 62 towards the leading end 3 of theimplant 100, thereby separating the movable base member 4 from theprimary base member 2, as illustrated in FIGS. 4F-G.

Those skilled in the art may appreciate that, in some embodiments, theexpandable spinal implant 100 may be configured to expand to a greaterwidth, effectively providing benefits of a larger implant, withoututilizing a larger incision. For example, in some embodiments, when inthe expanded configuration, the expandable spinal implant 100 may have awidth that is about 15-40% greater than the width in the collapsed orclosed configuration. In some embodiments, the expanded width of theimplant 100 may be about 20-35% greater than the expanded width.Advantageously, the expandable spinal implant 100 may be configured tomore evenly distribute the vertebral load, increase surface area contactwith the vertebral endplates, engage bone adjacent the apophyseal ring,reduce or inhibit cage subsidence, and/or promote increased fusion bybeing configured to receive more biomaterials, without increasing traumato the patient.

Some methods can also include disengaging the driver 106 from theimplant 100. This step can include rotating the inner shaft 108 untilthe key member 126 is aligned with the notch 44. This step can alsoinclude rotating the outer shaft 110 to unthread the distal threadedsection 118 from the actuator 8. The step can also include removing thedriver 106 from the implant 100. Optionally, a biomaterial may then beinserted into the expandable window 104 through the channel 74.

Some methods herein are directed to collapsing the implant 100. Thesemethods can include providing the implant 100 in the expandedconfiguration, as described herein, and collapsing the implant 100 bytranslating the actuator 8 from the leading end 3 of the implant 100 tothe trailing end 5 of the implant 100 to thereby bring together (e.g.,reduce the distance between) the movable base member 4 and the primarybase member 2. In some embodiments, the driver 106 can be used totranslate the actuator 8 from the leading end 3 to the trailing end 5.Those skilled in the art may appreciate that the same general stepsinvolved with expansion of the implant 100 may apply, except that theouter shaft 110 may be rotated in the opposite direction to translatethe actuator 8 towards the trailing end 5.

Turning now to FIGS. 5A-B, some embodiments herein are directed to anexpandable spinal implant 200 that can include a first (e.g., anterior)elongate body 202, a second (e.g., posterior) elongate body 204, a first(e.g., anterior) arm 206, a second (e.g., posterior) arm 208, and aconnector member (e.g., connector member 210). The implant 200 mayinclude a leading end 203 and a trailing end 205, as illustrated in FIG.5B. As described further herein, the first and/or second elongate bodies202, 204 may be configured to move (e.g., translate) relative to eachother. The expandable spinal implant 200 may advantageously beconfigured to transition between an expanded configuration and acollapsed or closed configuration, wherein the implant 200 has a width,as measured between an outer side surface of the first elongate body 202and an outer side surface of the second elongate body 204, that isgreater in the expanded configuration than in the collapsedconfiguration. In some embodiments, the implant 200 may have a collapsedwidth in the range of from about 10 mm to about 15 mm, and an expandedwidth in the range of from about 25 mm to about 30 mm. The first andsecond elongate bodies 202, 204 may define an expandable window 212therebetween. The expandable window 212 may be configured to receive afusion-enhancing material or other biomaterial, as described herein.

As illustrated in FIG. 5A, the first elongate body 202 can include aleading end 214 and a trailing end 216. The first elongate body 202 mayhave a length as measured between the leading end 214 and the trailingend 216. Although not limited to any particular orientation, in someembodiments the first elongate body 202 may be configured for anteriororientation in a patient and may thus be referred to as an anteriorelongate body. The first elongate body 202 can also include a superiorsurface 220, an inferior surface opposite the superior surface 220 (notshown), an inner side surface 224, and an outer side surface 226. Insome embodiments, at least a portion of the inner side surface 224 mayinclude an elongate slot or groove (not shown) extending longitudinallythereon. The first elongate body 202 may have a width as measuredbetween the inner side surface 224 and the outer side surface 226. Insome embodiments, the outer side surface 226 may be convex, as viewedfrom the superior and/or inferior surfaces. The superior surface 220and/or inferior surface may be convex, as viewed from the outer sidesurface 226, leading end 214, and/or trailing end 216. In otherembodiments, the superior surface 220 and/or inferior surface may beangled and/or slanted, such that the height of the first elongate body202 is greater at the outer side surface 226 than at the inner sidesurface 224. As described herein, the superior and/or inferior surfacesmay include a plurality of texturizing members.

As illustrated in FIGS. 5A-B, the leading end 214 of the first elongatebody 202 may be tapered. For example, the leading end 214 can include atapered height (e.g., as measured between the superior surface 220 andthe inferior surface) and/or a tapered width (e.g., as measured betweenthe inner side surface 224 and the outer side surface 226). In use, thetapered leading end 214 may advantageously be configured to distracttissue during insertion.

As illustrated in FIGS. 5A-B, the trailing end 216 of the first elongatebody 202 may be wider than the leading end 214. In some embodiments, thewidth of the trailing end 216 may be equal to the width of the implant200 in the collapsed configuration. The trailing end 216 can include achannel 228 extending therethrough. The channel 228 may include an axisthat is parallel to the length of the first elongate body 202. In someembodiments, the axis may be configured to intersect the connectormember 210. The channel 228 may be configured to receive a tool, such asa driver, therethrough. In some embodiments, the channel 228 may includea rounded or curved inner surface; in other embodiments, it may includean angled inner surface. In some embodiments, the channel 228 mayinclude a threaded interior. The channel 228 may not be fully enclosedand may be U-shaped. In some embodiments, the channel 228 may have anopening that extends at least partially along the inner side surface224. The trailing end 216 may also include a threaded hole 229 thatextends entirely therethrough, as illustrated in FIG. 5B. For example,the threaded hole 229 may be in fluid communication with the expandablewindow 212. The threaded hole 229 may extend along an axis that isparallel to the length of the first elongate body 202. The threaded hole229 may be configured to threadably receive a set screw therein. In someembodiments, the trailing end 216 and/or other section of the firstelongate body 202 can include a channel configured to receive bonegrowth material therethrough.

As illustrated in FIG. 5A, the second elongate body 204 can include aleading end 230 and a trailing end 232. The second elongate body 204 mayhave a length as measured between the leading end 230 and the trailingend 232. The length of the second elongate body 204 may be generallyequal to the length of the first elongate body 202. Although not limitedto any particular orientation, in some embodiments the second elongatebody 204 may be configured for posterior orientation in a patient andmay thus be referred to as a posterior elongate body. The secondelongate body 204 can also include a superior surface 234, an inferiorsurface opposite the superior surface 234 (not shown), an inner sidesurface 236, and an outer side surface 238. In some embodiments, atleast a portion of the inner side surface 236 may include an elongateslot or groove (not shown) extending longitudinally thereon. The secondelongate body 204 may have a width as measured between the inner sidesurface 236 and the outer side surface 238. In some embodiments, atleast a portion of the outer side surface 238 may be straight orgenerally straight (e.g., non-curved), as viewed from the superiorand/or inferior surfaces. The superior surface 234 and/or inferiorsurface may be convex, as viewed from the outer side surface 238,leading end 230, and/or trailing end 232. In other embodiments, thesuperior surface 234 and/or inferior surface may be angled and/orslanted, such that the height of the second elongate body 204 is less atthe outer side surface 238 than at the inner side surface 236. In someembodiments, the second elongate body 204 may have a maximum height thatis less than a maximum height of the first elongate body 202, so as tomatch the natural lordosis of a spine. In these embodiments, theexpandable spinal implant 200 may be wedge-shaped. In other embodiments,the expandable spinal implant 200 may have a constant height. Asdescribed herein, the superior and/or inferior surfaces may include aplurality of texturizing members.

The first arm 206 can include a proximal end 240 and a distal end 242.The proximal end 240 may extend into the expandable window 212. Theproximal end 240 can be configured to pivotably and/or hingedly engagethe second arm 208. For example, as illustrated in FIG. 5A, the proximalend 240 can include a gear member having teeth configured to mesh withgear teeth on the second arm 208. In other embodiments, the proximalends of the first and/or second arms 206, 208 may include some otherhinged connection member. The distal end 242 may be pivotably coupled tothe first elongate body 202. For example, the first arm 206 may beconfigured to pivot about a pin 244 that is coupled to both the firstarm 206 and the first elongate body 202. Accordingly, the first arm 206may be configured to pivot between a first angle, generally parallel tothe first elongate body 202, and a second angle, generally perpendicularto the first elongate body 202. The first arm 206 may be configured topivot in a plane (e.g., a horizontal plane) that is parallel to a planedefined by both the first and second elongate bodies 202, 204. The firstarm 206 may be configured to pivot about an axis that is perpendicularto the length of the first elongate body 202. In some embodiments, thefirst arm 206 may be coupled to the superior surface 220 of the firstelongate body 202. In other embodiments, the first arm 206 may becoupled to the inner side surface 224 and/or disposed within theelongate slot or groove (not shown). In yet other embodiments, the firstarm 206 may be coupled to the inferior surface (not shown) of the firstelongate body 202.

The first arm 206 may be coupled to the first elongate body 202 anywherealong the length thereof. As illustrated in FIG. 5A, the first arm 206may be located at the trailing end 216 of the first elongate body 202.In these embodiments, the first arm 206 may be configured to abut thetrailing end 216 of the first elongate body 202 when the implant 200 isin the expanded configuration. In some embodiments, the trailing end 216may prevent or inhibit the first arm 206 from pivoting beyond the lengthof the implant 200.

In some embodiments, the first arm 206 can extend in a straight orgenerally straight line between the proximal and distal ends 240, 242.In other embodiments, the first arm 206 can include one or more bends,kinks, curves, and/or angles, for example, as illustrated in FIG. 5A. Insome embodiments, a portion of the first arm 206 (e.g., the distal end242) may be bent at an angle in the range of from about 1 degree toabout 90 degrees relative to the rest of the first arm 206.

The second arm 208 can include some or all of the same features as thefirst arm 206. For example, the second arm 208 can include a proximalend 246 and a distal end 248. The proximal end 246 can extend into theexpandable window 212. The proximal end 246 can be configured to engagethe first arm 206. In some embodiments, the proximal end 246 may berotatably engaged with the first arm 206. In other embodiments, thefirst and second arms 206, 208 may be configured for at least partialrotational and/or pivotal motion with respect to one another. Asillustrated in FIG. 5A, in some embodiments, the proximal end 246 caninclude a gear member having teeth configured to mesh with gear teeth onthe first arm 206. The distal end 248 may be pivotably coupled to thesecond elongate body 204. For example, the first arm 208 may beconfigured to pivot about a pin 250 that is coupled to both the secondarm 208 and the second elongate body 204. The second arm 208 may beconfigured to pivot in a plane (e.g., a horizontal plane) that isparallel to a plane defined by both the first and second elongate bodies202, 204. The second arm 208 may be configured to pivot about an axisthat is perpendicular to the length of the first elongate body 202and/or parallel to the axis about which the first arm 206 may pivot. Insome embodiments, the second arm 208 may be coupled to the superiorsurface 220 of the second elongate body 204. In other embodiments, thesecond arm 208 may be coupled to the inner side surface 236 and/ordisposed within the elongate slot or groove (not shown). In yet otherembodiments, the second arm 208 may be coupled to the inferior surface(not shown) of the second elongate body 204. In some embodiments, thesecond arm 208 may be coupled to the second elongate body 204 in thesame place that the first arm 206 is coupled to the first elongate body202. For example, as illustrated in FIG. 5A, the first and second arms206, 208 may each be coupled to the superior surfaces 220, 234 of thefirst and second elongate bodies 202, 204. The second arm 208 may becoupled to the second elongate body 204 anywhere along the lengththereof. As illustrated in FIG. 5A, the second arm 208 may be alignedwith the first arm 206 along the length of the implant 200.

In some embodiments, the expandable spinal implant 200 may include atleast one pair of arms. As illustrated in FIG. 5A, the expandable spinalimplant 200 may include more than one pair of arms. For example, theexpandable spinal implant 200 can include two, three, four, or morepairs of arms. As illustrated in FIG. 5A, the expandable spinal implant200 can include three pairs (e.g., leading, central, and trailing), or atotal of six arms. In some embodiments, each arm in a pair may beidentical to the other arm in the pair. In other embodiments, one pairof arms may have different features as compared to another pair of armson the expandable spinal implant 200. For example, the trailing pair(e.g., including first and second arms 206, 208) may include bent arms,the central pair (e.g., including third and fourth arms 252, 254) mayinclude straight arms, and the leading pair (e.g., including fifth andsixth arms 256, 258) may include straight arms. Additionally, in someembodiments, each pair of arms may be coupled to different surfaces ofthe first and second elongate bodies 202, 204. For example, the trailingand leading pairs may be coupled to the superior surfaces 220, 234, andthe central pair may be disposed within a slot on the inner surfaces ofthe first and second elongate bodies 202, 204.

The connector member may be configured for linear translation, e.g.,along the length of the implant 200. The connector member may begenerally thin and flat, and can include at least two holes, eachconfigured to receive a pin therethrough. In some embodiments, theconnector member may be configured to translate towards and/or away fromthe leading and trailing ends of the implant 200. As illustrated in FIG.5A, the implant 200 may include at least one connector member 210coupled to the trailing pair of arms (e.g., first and second arms 206,208). The connector member 210 may include a tab 266 or other extensionmember extending towards the trailing end of the implant 200. The tab266 may be configured to engage an insertion tool as described furtherherein. The combination of the connector member 210 and the tab 266 maybe referred to herein as an enlarged connector member. As illustrated inFIG. 5A, connector member 210 may be pivotably coupled to the proximalends 240, 246 of the first and second arms 206, 208. In someembodiments, the implant 200 can include a pin 260 that is coupled tothe connector member 210 and the first arm 206. The implant 200 can alsoinclude a pin 262 that is coupled to the connector member 210 and thesecond arm 208. The connector member 210 may be coupled to a superior orinferior surface of the first and/or second arms 206, 208. In someembodiments, the connector member 210 may be connected to one or moreadditional connector members. For example, as illustrated in FIG. 5A,the connector member 210 may be connected to connector member 263 via astem 265. In some embodiments, all connector members of the implant 200may be interconnected. In other embodiments, at least one connectormember (e.g., connector member 210) may not be coupled to every otherconnector member of the implant 200. For example, as illustrated in FIG.5A, the connector member 210 may not be connected to the connectormember 264. Connector member 264 may be configured to pivotably coupletwo arms (e.g., fifth arm 256 and sixth arm 258).

Embodiments herein are also directed to methods of installing theexpandable spinal implant 200. These embodiments can include providingthe expandable spinal implant 200 in a collapsed (e.g., closed)configuration. In this configuration, the proximal end 240 of the firstarm 206 may be pivoted towards the first elongate body 202 and/or theleading end 214. The proximal end 246 of the second arm 208 may bepivoted towards the second elongate body 204 and/or the leading end 230.When in the collapsed configuration, the expandable spinal implant 200may have a first, collapsed width, as measured from the outer sidesurface 226 of the first elongate body 202 to the outer side surface 238of the second elongate body 204.

In some embodiments, the step of providing the expandable spinal implant200 in the collapsed configuration can include inserting the implant 200into a selected location, such as a cavity between two vertebral bodiescreated by a discectomy or other procedure. In some embodiments, thisstep can include reversibly coupling the implant 200 to an insertiontool, and using the insertion tool to guide the implant 200 into thecavity. The implant 200 can be inserted into the cavity using a varietyof approaches, such as anteriorly, posteriorly, transforaminally, orlaterally. In some embodiments, the implant 200 may advantageously beconfigured to be inserted into an intervertebral space using a lateralprocedure. Those skilled in the art may appreciate that, in someembodiments, when in the closed or collapsed configuration, theexpandable spinal implant 200 may have a width that is about 50-65% lessthan the width in the expanded configuration. In some embodiments, theclosed or collapsed width of the implant 200 may be about 55-60% lessthan the expanded width. In other embodiments, the closed or collapsedwidth of the implant 200 may be less than half of the expanded widththereof. Advantageously, the implant 200 may be inserted through asmaller, less-invasive opening that may result in reduced trauma tomuscles, nerves, or other tissue. When used in a lateral procedure(e.g., lateral lumbar interbody fusion), the implant 200 may be insertedlaterally in the far anterior side of the intervertebral space. Thistechnique can advantageously reduce or minimize interaction with theposteriorly-located lumbar plexus.

These methods can also include translating the connector member 210towards the trailing end 205 of the implant 200. This step can includegrasping the tab 266 and pulling the tab 266 towards the trailing end.As the connector member 210 is translated towards the trailing end, theproximal ends 240, 246 of the first and second arms 206, 208 may also betranslated towards the trailing end 205, thereby pushing apart thedistal ends 242, 248, as illustrated in FIGS. 5A-B. The connector member210 may be translated towards the trailing end 205 of the implant 200until the implant 200 attains a second width that is greater than thefirst width. In some embodiments, the second width may be 100-150%greater than the first width. In other embodiments, the second width maybe at least twice of the first width. In some embodiments, the connectormember 210 may translate towards the trailing end 205 until the firstarm 206 abuts the trailing end 216 of the first elongate body 202, asillustrated in FIG. 5B. In other embodiments, the connector member 210may be translated towards the trailing end until the first arm 206 isperpendicular to the first elongate body 202 and/or the second arm 208is perpendicular to the second elongate body 204. For example, theproximal ends 240, 246 may be fully extended away from the first andsecond elongate bodies 202, 204. Those skilled in the art may appreciatethat in other embodiments, the first and second arms 206, 208 may beangled towards the trailing end when in the collapsed configuration.Accordingly, the implant 200 may be expanded by translating theconnector member 210 towards the leading end, for example, by pushingthe tab 266.

In some embodiments, the step of translating the connector member 210can include manually (e.g., directly) grasping and applying force to theconnector member 210 and/or tab 266. In other embodiments, this step caninclude reversibly coupling an insertion tool to the connector member210. In some embodiments, the insertion tool can include alinearly-retractable arm that extends proximally from a grabbing member.Those skilled in the art may appreciate that, with respect to theinsertion tool, the terms “proximal” and “distal” are utilized withreference to a user of the tool. The grabbing member may be configuredto engage (e.g., grasp) the connector member 210 and/or tab 266 and mayinclude, for example, a clamp, claw, or pincers. The grabbing member maybe configured to pass at least partially through the channel 228 of thefirst elongate body 202. The insertion tool may also include a grabbingactuator engaged with and configured to actuate the grabbing member. Forexample, the grabbing actuator may cause the grabbing member to graspand/or release the tab 266. The insertion tool may also include an armactuator engaged with and configured to extend and/or retract the arm.One or both actuators may include a knob, button, switch, lever, and/orother user interface members. The insertion tool may also include ahandle at a proximal end of the tool (e.g., extending proximally fromthe retractable arm). In some embodiments, the handle may house one orboth actuators. The insertion tool may also include a docking memberconfigured to reversibly engage the implant 200, as described herein.For example, the docking member may include a threaded rod that isconfigured to threadably engage the implant 200. In some embodiments,the insertion tool may also include a cannula extending longitudinallyand/or axially therethrough. Advantageously, the cannula may beconfigured to transport bone graft material to the expandable window212. The insertion tool may also include a driver (e.g., a screw driver)configured to engage the set screw disposed within the threaded hole ofthe trailing end 216 of the first elongate body 202.

In some embodiments, the step of coupling the insertion tool with theconnector member 210 may include inserting the grabbing member into theexpandable window 212 through the channel 228, and may further includeactuating the grabbing member to grasp the tab 266. Subsequently, aforce may be applied to the insertion tool to translate the connectormember 210. The step of applying force to the insertion tool can includeapplying force to the arm actuator, thereby retracting the arm of theinsertion tool, translating the connector member 210, and expanding theimplant 200.

Methods herein may further include the step of securing or locking theimplant 200 in the expanded configuration. This step can includethreading the set screw through the threaded hole 229 at the trailingend 216 of the first elongate body 202 and into contact with the firstarm 206. In some embodiments, the set screw may be engaged with thefirst arm 206 in an interference fit. Those skilled in the art mayappreciate that the force applied by the set screw may prevent orinhibit the first arm 206 from returning to its collapsed orientation.

Bone graft material may also be inserted through the cannula of theinsertion tool to the expandable window 212. In some embodiments, bonegraft material may be inserted through the channel 228 and/or through aseparate window on the first and/or second elongate bodies 202, 204.Thereafter, the insertion tool may be disengaged from the implant 200.This step may include releasing the connector member 210 and/or tab 266and removing the grabbing member through the channel 228. This step mayalso include disengaging (e.g., unthreading and/or unlocking) theinsertion tool from the implant 200.

Turning now to FIGS. 6A-E, some embodiments herein are directed to anexpandable spinal implant 400 that can include a first elongate body402, a second elongate body 404, and a first expansion assembly 406. Theexpandable spinal implant 400 may include a length defined between aleading end 403 and a trailing end 405. The expandable spinal implant400 may also include a width defined between an outer side surface 414of the first elongate body 402 and an outer side surface 426 of thesecond elongate body 404. The expandable spinal implant 400 mayadvantageously be configured to transition reversibly between anexpanded configuration and a collapsed configuration. The implant 400may have a width in the expandable configuration that is greater than awidth in the collapsed configuration. In some embodiments, the implant400 may have a collapsed width in the range of from about 10 mm to about15 mm, and an expanded width in the range of from about 25 mm to about30 mm.

As illustrated in FIG. 6A, the first elongate body 402 can include aleading end 406 and a trailing end 408. The first elongate body 402 mayhave a length as measured between the leading end 406 and the trailingend 408. Although not limited to any particular orientation, in someembodiments the first elongate body 402 may be configured for anteriororientation in a patient and may thus be referred to as an anteriorelongate body. The first elongate body 402 can include a superiorsurface 410, an inferior surface opposite the superior surface 410 (notshown), an inner side surface 412, and an outer side surface 414. Insome embodiments, at least a portion of the inner side surface 412 mayinclude an elongate guide member (e.g., a groove, channel, rail, slot,and/or track) (not shown) extending longitudinally thereon. The elongateguide member may be configured to engage the first expansion assembly406 or a portion thereof, as described herein. The inner side surface412 may also include a locking member (not shown), such as a stop orbump, configured to inhibit translation of the first expansion assembly406 beyond the locking member. The first elongate body 402 may have awidth as measured between the inner side surface 412 and the outer sidesurface 414. In some embodiments, the width of the first elongate body402 may be generally equal to one-half of the width of the implant 400in the collapsed configuration. In some embodiments, the outer sidesurface 414 may be convex, as viewed from the superior and/or inferiorsurfaces. The superior surface 410 and/or inferior surface may beconvex, as viewed from the outer side surface 414, leading end 406,and/or trailing end 408. In other embodiments, the superior surface 410and/or inferior surface may be angled and/or slanted, such that theheight of the first elongate body 402 is greater at the outer sidesurface 414 than at the inner side surface 412. As described herein, thesuperior and/or inferior surfaces may include a plurality of texturizingmembers.

In some embodiments, the leading end 406 of the first elongate body 402may be tapered. For example, the leading end 406 can include a taperedheight (e.g., as measured between the superior surface 410 and theinferior surface) and/or a tapered width (e.g., as measured between theinner side surface 412 and the outer side surface 414). In use, thetapered leading end 406 may advantageously be configured to distracttissue during insertion.

In some embodiments, the first elongate body 402 may have a generallyconstant width. In other embodiments, the width of the trailing end 408may be generally equal to the width of the leading end 406. In someembodiments, the first elongate body 402 may include a longitudinalcavity 416 extending at least partially therethrough. The longitudinalcavity 416 may include an opening at the trailing end 408 of the firstelongate body 402. The longitudinal cavity 416 may be configured toreceive a tool, such as a driver, therethrough. In some embodiments, thelongitudinal cavity 416 may include a locking member, such as a pin orprotrusion, configured to restrain the tool therein. In someembodiments, the longitudinal cavity 416 may be cylindrical (e.g., mayinclude a constant, circular diameter). The longitudinal cavity 416 maypass through (e.g., may not intersect) the superior surface 410 and/orinferior surface. In some embodiments, the longitudinal cavity 416 mayintersect one or more additional passageways of the implant 400. In someembodiments, the first wedge member 432, described further herein, maybe accessible through the longitudinal cavity 416 of the first elongatebody 402. The trailing end 408, or other portion of the first elongatebody 402, may also include one or more windows configured to receivebone growth material therethrough.

As illustrated in FIG. 6A, the second elongate body 404 can include aleading end 418 and a trailing end 420. The second elongate body 404 mayhave a length as measured between the leading end 418 and the trailingend 420. The length of the second elongate body 404 may be generallyequal to the length of the first elongate body 402. Although not limitedto any particular orientation, in some embodiments the second elongatebody 404 may be configured for posterior orientation in a patient andmay thus be referred to as a posterior elongate body. The secondelongate body 404 can include a superior surface 422, an inferiorsurface opposite the superior surface 422 (not shown), an inner sidesurface 424, and an outer side surface 426. In some embodiments, atleast a portion of the inner side surface 424 may include an elongateguide member (e.g., a groove, channel, rail, slot, and/or track) (notshown) extending longitudinally thereon. The elongate guide member maybe configured to engage the first expansion assembly 406 or a portionthereof, as described herein. The inner side surface 424 may alsoinclude a locking member (not shown), such as a stop or bump, configuredto inhibit translation of the first expansion assembly 406 beyond thelocking member. The second elongate body 404 may have a width asmeasured between the inner side surface 424 and the outer side surface426. The width of the second elongate body 404 may be less than, greaterthan, or equal to the width of the first elongate body 402. In someembodiments, the width of the second elongate body 404 may be generallyequal to one-half of the width of the implant 400 in the collapsedconfiguration. In some embodiments, at least a portion of the outer sidesurface 426 may be straight or generally straight (e.g., non-curved), asviewed from the superior and/or inferior surfaces. The superior surface422 and/or inferior surface may be convex, as viewed from the outer sidesurface 426, leading end 418, and/or trailing end 420. In otherembodiments, the superior surface 422 and/or inferior surface may beangled and/or slanted, such that the height of the second elongate body404 is less at the outer side surface 426 than at the inner side surface424. In some embodiments, the second elongate body 404 may have amaximum height that is less than a maximum height of the first elongatebody 402, so as to match the natural lordosis of a spine. In theseembodiments, the expandable spinal implant 400 may be wedge-shaped. Inother embodiments, the expandable spinal implant 400 may have a constantheight. As described herein, the superior and/or inferior surfaces mayinclude a plurality of texturizing members.

As illustrated in FIG. 6A, the first expansion assembly 406 can includea first (e.g., anterior) ramp member 428, a second (e.g., posterior)ramp member 430, and a first wedge member 432. The first ramp member 428may be configured to slideably engage the first elongate body 402 and/orthe first wedge member 432. The first ramp member 428 can include aproximal surface 434, a distal surface 436, an inner surface 438, and anouter surface 440. The inner and outer surfaces 438, 440 may be parallelto each other. In some embodiments, the proximal and distal surfaces434, 436 may be perpendicular to each other. In these embodiments, thefirst ramp member 428 may be trapezoidal. In other embodiments, theproximal and distal surfaces 434, 436 may be parallel to each other. Inthese embodiments, the first ramp member 428 may beparallelogram-shaped. The first ramp member 428 may have a width that isnot greater than the width of the first elongate body 402, for example,as illustrated in FIG. 6D. Furthermore, as illustrated in FIG. 6D, whenin the collapsed configuration, the first ramp member 428 may occupy nomore than half of the width of the implant 400. In some embodiments, theproximal surface 434 may be generally parallel to the length of thefirst and/or second elongate bodies 402, 404. In other embodiments, theproximal surface 434 may be generally perpendicular to the length of thefirst and/or second elongate bodies 402, 404. The distal and/or outersurfaces 436, 440 may include a corresponding mating feature, such as atab or protrusion, configured to engage the guide member of the firstelongate body 402.

The first ramp member 428 may include an axis that extends parallel tothe inner and outer surfaces 438, 440. In some embodiments, the axis ofthe first ramp member 428 may extend at an angle away from the firstelongate body 402. For example, the angle may be in the range of fromabout 10 degrees to about 80 degrees. In some embodiments, the angle maybe in the range of from about 30 degrees to about 60 degrees. In someembodiments, the first ramp member 428 may be angled towards thetrailing end 405 of the implant 400, for example, as illustrated in FIG.6A. In other embodiments, the first ramp member 428 may be angledtowards the leading end 403. In some embodiments, the inner surface 438of the first ramp member 428 may include an elongate guide member (e.g.,a groove, channel, rail, slot, and/or track) (not shown) extendinglongitudinally thereon. The elongate guide member may be configured toslideably engage the first wedge member 432. The inner surface 438 mayalso include a locking member (not shown), such as a stop or bump,configured to inhibit translation of the first wedge member 432 beyondthe locking member. In some embodiments, the inner and/or outer surfaces438, 440 may include at least one retention member, such as a ratchet orangled tooth, that can be configured to inhibit translation of the firstramp member 428 and/or the first wedge member 432 in one direction(e.g., towards the leading end 403).

The second ramp member 430 can be configured to slideably engage thesecond elongate body 404 and/or the first wedge member 432. The secondramp member 430 can include some or all of the same features as thefirst ramp member 428. In some embodiments, the second ramp member 430may be symmetrical to and/or may be a mirror image of the first rampmember 428.

The first wedge member 432 may be configured to slideably engage thefirst and second ramp members 428, 430. As illustrated in FIG. 6A, thefirst wedge member 432 may include an anterior surface 442, a posteriorsurface 444, and a lateral surface 446. Those skilled in the art mayappreciate that these and other directional terms herein are used fordescriptive purposes and do not limit the orientation in which any ofthe expandable spinal implants described herein may be used. Asillustrated in FIG. 6A, the first wedge member 432 may include atriangular cross-section. The anterior surface 442 may be configured toengage a portion of the first ramp member 428 (e.g., inner surface 438)and the posterior surface 444 may be configured to engage a portion ofthe second ramp member 430 (e.g., an inner surface thereof). Theanterior and/or posterior surfaces 442, 444 may include a matingfeature, such as a tab or protrusion, configured to engage the elongateguide members on the inner surfaces of the first and second ramp members428, 430. In some embodiments, the anterior and/or posterior surfaces442, 444 may include at least one retention member, such as a ratchet orangled tooth, that can be configured to inhibit translation of the firstwedge member 432 in one direction (e.g., towards the leading end 403).

The first wedge member 432 may include an anterior angle between theanterior surface 442 and the lateral surface 446, and a posterior anglebetween the posterior surface 444 and the lateral surface 446. In someembodiments, the anterior angle may be equal to the posterior angle. Inother embodiments, the anterior angle may be greater than or less thanthe posterior angle. In some embodiments, the angle between the anteriorand posterior surfaces 442, 444 may be generally equal to an anglebetween the inner surfaces of the first and second ramp members 428,430, when the first and second ramp members are in contact with eachother (e.g., when the proximal walls are in contact with each other).The first wedge member 432 may have a width that is equal to a width ofthe lateral surface 446 between the anterior and posterior surfaces 442,444. In some embodiments, the width of the first wedge member 432 maynot be more than twice the width of the first elongate body 402. In someembodiments, the width of the first wedge member 432 may not be greaterthan the width of the implant 400.

In some embodiments, the expandable spinal implant 400 may include oneexpansion assembly. In other embodiments, the expandable spinal implant400 may include two, three, four, or more expansion assemblies. Asillustrated in FIG. 6C, the expandable spinal implant 400 can includefirst expansion assembly 406 and second expansion assembly 407. In someembodiments, the expansion assemblies may be configured to translate inthe same direction and/or the wedge members may be pointed towards thesame end (e.g., towards the trailing end 405 or leading end 403). Inother embodiments, the expansion assemblies may be configured totranslate in different directions, and/or the wedge members may bepointed in opposite directions. For example, as illustrated in FIG. 6C,the first expansion assembly 406 may be configured to translate towardsthe trailing end 405 and the second expansion assembly 407 may beconfigured to translate towards the leading end 403.

In some embodiments, the expandable spinal implant 400 may furtherinclude a first collar 448 configured to engage the first expansionassembly 406 or a portion thereof (e.g., the first wedge member 432), asillustrated in FIG. 6C. The first collar 448 may include a distal end450 disposed within the longitudinal cavity 416 and a proximal end 452configured to engage the first wedge member 432. The distal end 450 mayinclude a threaded hole extending therethrough and configured to becoaxial with the longitudinal cavity 416. The first collar 448 may be inslideable engagement with the first wedge member 432. As illustrated inFIG. 6C, in some embodiments, the first collar 448 may be engaged withthe lateral surface 446 of the first wedge member 432. In otherembodiments, the first wedge member 432 may include a receptacleconfigured to receive the proximal end 452 of the first collar 448therein, for example, as illustrated in FIG. 6E. As described herein, insome embodiments, the expandable spinal implant 400 may include two ormore expansion assemblies. The implant 400 may also include a separatecollar for each expansion assembly. For example, as illustrated in FIG.6C, implant 400 includes first and second expansion assemblies 406, 407and first and second collars 448, 449.

In some embodiments, the expandable spinal implant 400 may furtherinclude an elongate rod 454 configured to be housed and/or disposedwithin the longitudinal cavity 416 of the first elongate body 402, forexample, as illustrated in FIG. 6C. The elongate rod 454 may beconfigured to rotate within the longitudinal cavity 416. The elongaterod 454 may include a leading end 456 and a trailing end 458. Thetrailing end 458 may include a tool-engaging surface configured toengage a driver. For example, the trailing end 458 may include a socketconfigured to couple with a driver, such as a hexagonal, star, Phillips,and/or slotted. The elongate rod 454 may include a first threadedsection 460 between the leading and trailing ends 456, 458. In someembodiments that include two expansion assemblies, the elongate rod 454may also include a second threaded section 462 between the leading andtrailing ends 456, 458. The threads of the first section 460 may extendin a direction opposite the threads of the second section 462 (e.g.,clockwise and counterclockwise, or vice versa). The first threadedsection 460 may be configured to engage the first collar 448 and thesecond threaded section 462 may be configured to engage the secondcollar 449. In some embodiments, the first elongate body 402 may includeat least one retention member, such as a pin or keyed hole, which may beconfigured to inhibit longitudinal translation of the elongate rod 454within the longitudinal cavity 416. In some embodiments, the elongaterod 454 may include a receptacle, such as a circumferential groove orundercut, that may be configured to receive or engage the retentionmember.

Embodiments herein are also directed to methods of installing theexpandable spinal implant 400. These methods can include providing theexpandable spinal implant 400 in the collapsed configuration, forexample, as illustrated in FIG. 6D.

In some embodiments, the step of providing the expandable spinal implant400 in the collapsed configuration can include inserting the implant 400into a selected location, such as a cavity between two vertebral bodiescreated by a discectomy or other procedure. In some embodiments, thisstep can include reversibly coupling the implant 400 to an insertiontool, and using the insertion tool to guide the implant 400 into thecavity. The implant 400 can be inserted into the cavity using a varietyof approaches, such as anteriorly, posteriorly, transforaminally, orlaterally. In some embodiments, the implant 400 may advantageously beconfigured to be inserted into an intervertebral space using a lateralprocedure. Those skilled in the art may appreciate that, in someembodiments, when in the closed or collapsed configuration, theexpandable spinal implant 400 may have a width that is about 50-65% lessthan the width in the expanded configuration. In some embodiments, theclosed or collapsed width of the implant 400 may be about 55-60% lessthan the expanded width. In other embodiments, the closed or collapsedwidth of the implant 400 may be less than half of the expanded widththereof. Advantageously, the implant 400 may be inserted through asmaller, less-invasive opening that may result in reduced trauma tomuscles, nerves, or other tissue. When used in a lateral procedure(e.g., lateral lumbar interbody fusion), the implant 400 may be insertedlaterally in the far anterior side of the intervertebral space. Thistechnique can advantageously reduce or minimize interaction with theposteriorly-located lumbar plexus.

In embodiments where the expandable spinal implant 400 includes theelongate rod 454, these methods can also include rotating the elongaterod 454. This step can include engaging the elongate rod 454, forexample, with a driver such as a hex key. The driver may be part of theinsertion tool. Torque may then be applied to the driver, therebyrotating the elongate rod 454. As the elongate rod 454 rotates, thefirst collar member 448 may translate along the elongate rod 454 in afirst direction, e.g., towards the trailing end 405. The first collar448 may urge the first wedge member 432 to translate in the samedirection, thus urging and/or pushing the first and second ramp members428, 430 apart, and consequently separating the first and secondelongate bodies 402, 404 until the implant 400 attains a second,expanded width that is greater than the closed or collapsed width, asillustrated in FIG. 6B. In some embodiments, as the first wedge member432 is translated towards the leading and/or trailing ends 403, 405, thefirst wedge member 432 may also slide along the proximal end 452 of thefirst collar 448, as illustrated in FIG. 6E.

In some embodiments, the expandable spinal implant 400 can also includesecond expansion assembly 407, and the elongate rod 454 can also includesecond threaded section 462, as illustrated for example in FIG. 6C. Inthese embodiments, as the elongate rod 454 rotates, the first collar 448may translate along the elongate rod 454 in a first direction, e.g.,towards the trailing end 405, and the second collar 449 may translatealong the elongate rod 454 in a second direction, e.g., towards theleading end 403. The first collar 448 may urge the first wedge member432 to translate in the first direction and the second collar 449 mayurge a second wedge member of the second expansion assembly 407 totranslate in the second direction. As illustrated in FIG. 6C, the firstand second expansion assemblies may translate away from each other asthe implant 400 expands, thereby creating a cavity 464 therebetween.

In other embodiments, the expandable spinal implant 400 may not includeelongate rod 454. In these embodiments, the implant 400 can be expandedusing a driver (not shown). The driver can include an elongate rodassembly that can include a leading end, a trailing end, and a firstthreaded section between the leading and trailing ends. Methods ofinstalling the expandable spinal implant 400 can include providing theimplant in the collapsed configuration as described herein and insertingthe driver into the longitudinal cavity 416. The methods can alsoinclude coupling the first threaded section of the elongate rod assemblywith the first collar 448. The driver can also be coupled to the firstelongate body 402, for example, to inhibit longitudinal translation ofthe driver. The methods can also include rotating the elongate rodassembly, thereby translating the first collar 448 and the first wedgemember 432, and urging the first and second elongate bodies 402, 404apart until the implant 400 attains an expanded width that is greaterthan the collapsed width.

In embodiments where the expandable spinal implant 400 includes secondexpansion assembly 407, the elongate rod assembly can additionallyinclude a second threaded section between the leading and trailing ends.In these embodiments, the method of installing the implant 400 can alsoinclude coupling the second end of the elongate rod with the secondcollar 449 prior to rotating the elongate rod assembly. In someembodiments, the threads of the first section can extend in a directionopposite the threads of the second section (e.g., clockwise andcounterclockwise, or vice versa). In other embodiments, they can extendin the same direction.

In some embodiments, the elongate rod assembly can include a first rodmember concentrically disposed within a cannula of a second rod member.The first threaded section may be disposed on the first rod member andthe second threaded section may be disposed on the second rod member.The first rod member may be configured to extend and retract from withinthe second rod member. The first and second rod members may beconfigured to rotate independently of each other. In these embodiments,the step of rotating the elongate rod assembly can include rotating thefirst rod member to translate the first wedge member 432 in a firstdirection and rotating the second rod member to translate the secondwedge member in a second direction.

In some embodiments, the method can further include locking or securingthe expandable implant 400 in the expanded configuration. This step caninclude threading a set screw into the implant 400 to block or preventthe one or more expansion assemblies from retracting to their collapsedpositions. In other embodiments, one or more components of the implant400 may include a retention member, such as a ratchet or angled tooth,which may be configured to prevent the one or more expansion assembliesfrom retracting. In yet other embodiments, the implant 400 may beself-locking.

Some methods herein can further include disengaging the insertion tooland/or driver from the implant 400. In embodiments that include theelongate rod 454, this step can include disengaging the insertion toolfrom the elongate rod 454. In embodiments that do not include theelongate rod 454, this step can include disengaging (e.g., unthreading)the driver from the first and second collars 448, 449. Methods hereincan also include inserting bone graft material into the cavity 464. Insome embodiments, this step may be accomplished before the insertiontool and/or driver is disengaged from the implant 400. In theseembodiments, the insertion tool and/or driver may include a cannulathrough which the bone graft material may be transported to the implant400, for example, via the longitudinal cavity 416. In other embodiments,the bone graft material may be inserted after the insertion tool and/ordriver is removed. In these embodiments, the bone graft material may beinserted, e.g., through the longitudinal cavity 416 and/or through agraft window on at least one of the first and second elongate bodies402, 404.

Turning now to FIGS. 7A-C, some embodiments herein are directed to anexpandable spinal implant 600 that can include an elongate body 602, afirst (e.g., leading) arm 608, and a second (e.g., trailing) arm 610.The expandable spinal implant 600 may include a length defined between aleading end 603 and a trailing end 605. The expandable implant 600 mayalso include a width defined from an anterior side surface 620 of theelongate body 602 to a medial end of the first and/or second arms 608,610, as illustrated in FIG. 7B. The expandable spinal implant 600 mayadvantageously be configured to transition reversibly between anexpanded configuration and a collapsed configuration. The implant 600may have a width in the expandable configuration that is greater than awidth in the collapsed configuration.

As illustrated in FIG. 7A, the elongate body 602 can include a first(e.g., leading) end 612 and a second (e.g., trailing) end 614. Theelongate body 602 may have a length as measured between the first end612 and the second end 614. The second end 614 may be configured toengage an insertion tool. As illustrated in FIG. 7A, the second end 614may include a threaded receptacle 615 configured to threadably engagethe insertion tool. The elongate body 602 may include an upper wall 616,a lower wall 617 opposite the upper wall, a posterior side surface 618,and an anterior side surface 620. Those skilled in the art mayappreciate that these and other directional terms herein are used fordescriptive purposes and do not limit the orientation in which any ofthe expandable spinal implants described herein may be used. Theelongate body 602 may have a width as measured between the anterior sidesurface 620 and the posterior side surface 618. In some embodiments, thewidth of the elongate body 602 may be generally equal to the width ofthe implant 600 in the collapsed configuration. In some embodiments, theelongate body 602 may include a cutout 632 that passes through the upperwall 616, lower wall 617, and/or posterior side surface 618.Accordingly, the cutout 632 may define a posterior opening along theposterior side surface 618. In some embodiments, the anterior sidesurface 620 may be convex, as viewed, for example, from the upper wall616 and/or lower wall 617. The upper and/or lower walls 616, 617 mayextend between the first end 612 and the second end 614. The elongatebody 602 may be at least partially hollow. The upper wall 616 mayinclude a superior (e.g., outer) and/or inferior (e.g., inner) surface.The lower wall 617 may also include a superior (e.g., inner) surfaceand/or an inferior (e.g., outer) surface. As described herein, the outersurfaces of the upper and/or lower walls 616, 617 may include aplurality of texturizing members. In some embodiments, the outersurfaces of the upper and/or lower walls 616, 617 may be convex, asviewed from the anterior side surface 620, posterior side surface 618,leading end 612, and/or trailing end 614. In other embodiments, theouter surfaces of the upper and/or lower walls 616, 617 may be angledand/or slanted, such that the height of the elongate body 602 is greaterat the anterior side surface 620 than at the posterior side surface 618.In these embodiments, the expandable spinal implant 600 may bewedge-shaped. In other embodiments, the expandable spinal implant 600may have a constant height.

In some embodiments, the elongate body 602 may be tapered at the leadingend 612. For example, the leading end 612 can include a tapered height(e.g., as measured between the outer surfaces of the upper wall 616 andthe lower wall 617) and/or a tapered width (e.g., as measured betweenthe anterior side surface 620 and the posterior side surface 618). Inuse, the tapered leading end 612 may advantageously be configured todistract tissue during insertion.

The inferior surface of the upper wall 616 and/or the superior surfaceof the lower wall 617 can include one or more guide members (e.g., agroove, channel, rail, slot, track, rack, and/or pinion). In someembodiments, the guide member(s) on the upper wall 616 may be parallelto the guide member(s) on the lower wall 617. The guide member(s) may bestraight or curved. In some embodiments, one or more guide member(s) canbe located at the leading and/or trailing ends 612, 614. For example,the inferior surface can include first and second grooves 622, 624 atthe trailing end 614, as illustrated in FIGS. 7A-B. In some embodiments,the first groove 622 may be an anterior groove and the second groove 624may be a posterior groove. The first and second grooves 622, 624 may beparallel or non-parallel to each other. In some embodiments, the firstand/or second grooves 622, 624 may extend along an axis that is parallelto a longitudinal axis of the implant 600. As illustrated in FIGS. 7A-B,the first and second grooves 622, 624 may be separated by a distancethat decreases towards the leading end 612. The first and second grooves622, 624 may each have a first end closer to the trailing end 614 and asecond end closer to the leading end 612. In some embodiments, the firstand second grooves 622, 624 may be separated by a distance thatdecreases towards the leading end 612. The inferior surface of the upperwall 616 can also include a groove 626 at the leading end 612. Thegroove 626 may extend along an axis parallel to the longitudinal axis ofthe implant 600.

The elongate body 602 may include a passageway 628 extending at leastpartially along the length thereof. The passageway 628 may also includean opening 630 at the trailing end 614 of the elongate body 602. Thepassageway 628 may pass between (e.g., may not intersect) the upper andlower walls 616, 617. The passageway 628 may be in fluid communicationwith the cutout 632. As illustrated in FIGS. 7A-B, the implant 600 mayalso include an actuator 604. The actuator 604 may be housed within theelongate body 602. In some embodiments, the actuator may be disposedwithin the passageway 628. The actuator 604 may be configured toactivate the first and second arms as described herein. In someembodiments, the actuator 604 may include a rod having a threadedsection and/or a non-threaded section. The actuator 604 may also includea tool-engaging surface 636 at a trailing end thereof. For example, thetool-engaging surface 636 can include a socket for coupling a driver,such as a hexagonal, star, Phillips, and/or slotted driver. The actuator604 may be configured to rotate within the passageway 628 along alongitudinal axis thereof. In some embodiments, the rod 634 may furtherinclude a circumferential groove 638. In some embodiments, the implant600 may include one or more retention members configured to inhibittranslation of the actuator 604 along the passageway 628. For example,as illustrated in FIG. 7A, the implant 600 may include first and secondpins 640, 642. The first and second pins 640, 642 may be configured tobe received within the circumferential groove 638. In some embodiments,the first and second pins 640, 642 may each have a height that is notgreater than the height of the implant 600, and may advantageously notincrease the profile thereof.

In some embodiments, the expandable spinal implant 600 may also includea translatable connector 606. The translatable connector 606 may beconfigured to engage the actuator 604 and translate relative thereto.The translatable connector 606 may also be configured to engage thefirst arm 608. As illustrated in FIG. 7B, the translatable connector 606may include a body portion 644 and an arm portion 646. The body portion644 may include partially-threaded section, such as a threaded, U-shapedchannel. The threaded, U-shaped channel may be configured to threadablymate with the threaded section of the actuator 604. The translatableconnector 606 may also include a slot 648. As illustrated in FIG. 7B,the slot 648 may be disposed within the arm portion 646 of thetranslatable connector 606. The slot 648 may extend entirely through thetranslatable connector 606. For example, the slot 648 may have a lengththat extends from a top surface to a bottom surface of the translatableconnector 606. The slot 648 may include a longitudinal axis that isperpendicular to the axis of the U-shaped channel. The slot 648 may alsohave an elongate cross-sectional shape. The slot 648 may define a pathhaving a first end and a second end, wherein the second end is posteriorto the first end. The slot 648 may be configured to receive a portion ofthe first arm 608 therein. In some embodiments, the first arm 608 may beconfigured to translate along the path defined by the slot 648.

The first arm 608 may be pivotably coupled to the translatable connector606. The first arm 608 may also be pivotably, translationally, and/orslideably coupled to the elongate body 602, for example, at the firstend 612. The first arm 608 may include a lateral end 650 and a medialend 652, as illustrated in FIG. 7B. The first arm 608 may also include asuperior surface 654 and an inferior surface (not shown) opposite of thesuperior surface 654. In some embodiments, the first arm 608 may be aunitary body. In other embodiments, the first arm 608 may includemultiple pieces or segments. The lateral end 650 of the first arm 608may be coupled to the translatable connector 606 and/or the elongatebody 602. The lateral end 650 may include a post. The post may beconfigured to be received within the slot 648 of the translatableconnector 606. As described herein, the post may be configured totranslate reversibly along the path defined by the slot 648.

In some embodiments, the first arm 608 may include at least oneprotrusion (e.g., bump, tab, and/or gear member) on a superior and/orinferior surface thereof. For example, the first arm 608 may includeprotrusion 656 on the superior surface 654 and at the lateral end 650thereof. The protrusion may be configured to engage and/or mate with oneof the guide members on the elongate body 602. As illustrated in FIGS.7A-B, the protrusion 656 may be configured to be received within thegroove 626 at the leading end 612 of the elongate body 602. The firstarm 608 may include another protrusion on the inferior surface and atthe lateral end 650 thereof. This protrusion may be configured to bereceived within a groove on the superior (e.g., inner) surface of thelower wall 617 of the elongate body 602. In use, those skilled in theart may appreciate that the protrusion 656 (alone or in combination withone or more protrusions on the inferior surface) may guide the first arm608 along the path defined by the groove 626, and may enable to thefirst arm 608 to pivot relative thereto. Additionally, those skilled inthe art may appreciate that in other embodiments, the elongate body 602may include one or more protrusions and the first and/or second arms608, 610 may include one or more guide members. The first arm 608 mayinclude curved or angled anterior (e.g., inner) and/or posterior (e.g.,outer) surfaces. For example, as illustrated in FIGS. 7A-B, the firstarm 608 can include a curved anterior surface and an angled posteriorsurface. The first arm 608 may have a height that is not greater thanthe height of the elongate body 602. When the implant 600 is in thecollapsed configuration, the first arm 608 may be configured to notprotrude beyond the anterior and/or posterior side surfaces 620, 618 ofthe elongate body 602.

The second arm 610 may be pivotably, translationally, and/or slideablycoupled to the elongate body 602, for example, at the second end 614.The second arm 610 may include a lateral end 658 and a medial end 660,as illustrated in FIG. 7B. The second arm 610 may also include asuperior surface 662 and an inferior surface (not shown) opposite of thesuperior surface 662. The lateral end 658 of the second arm 610 may becoupled to the elongate body 602. In some embodiments, the second arm610 may include at least one protrusion on a superior and/or inferiorsurface thereof. For example, the second arm 610 may include a first(e.g., anterior) protrusion 664 and a second (e.g., posterior)protrusion 666 at the lateral end 658 thereof. As illustrated in FIGS.7A-B, the first protrusion 664 may be configured to be received withinthe first groove 622. The second protrusion 666 may be configured to bereceived within the second groove 624. The second arm 610 may includecorresponding first and second protrusions on the inferior surfacethereof. These protrusions may be configured to be received within firstand second grooves on the superior (e.g., inner) surface of the lowerwall 617 of the elongate body 602. In use, those skilled in the art mayappreciate that the protrusions 664, 666 may guide the second arm 610along the path defined by the grooves 622, 624, and may enable thesecond arm 610 to pivot relative thereto. The second arm 610 may includecurved or angled anterior (e.g., inner) and/or posterior (e.g., outer)surfaces. For example, as illustrated in FIGS. 7A-B, the second arm 610can include a curved anterior surface and an angled posterior surface.The second arm 610 may have a height that is not greater than the heightof the elongate body 602. When the implant 600 is in the collapsedconfiguration, the second arm 610 may be configured to not protrudebeyond the anterior and/or posterior side surfaces 620, 618 of theelongate body 602.

The first and second arms 608, 610 may be pivotably and/or hingedlycoupled to each other. For example, the medial end 652 of the first arm608 may be pivotably coupled to the medial end 660 second arm 610. Asillustrated in FIGS. 7A-B, the medial end 652 of the first arm 608 mayinclude a rounded (e.g., circular and/or cylindrical) hole 668. Therounded hole 668 may pass through the first arm 608 from the superiorsurface 662 to the inferior surface. The medial end 660 of the secondarm 610 may include a pin 670. The pin 670 may be configured to bepivotably received within the rounded hole 668. In other embodiments,the first arm 608 may include a pin and the second arm 610 may include arounded hole configured to pivotably receive the pin therein. Thoseskilled in the art may appreciate that the medial ends 652, 660 of thefirst and second arms 608, 610 may be configured to reversibly pivottowards and away from the elongate body 602. In the collapsedconfiguration, the medial ends 652, 660 may be pivoted towards theelongate body 602. In the expanded configuration, the medial ends 650,660 may be pivoted away from the elongate body 602. The implant 600 mayalso include an expandable cavity 672. The expandable cavity 672 may bedefined by the cutout 632 and the anterior surfaces of the first andsecond arms 608, 610. When in the expanded configuration, for example,as illustrated in FIG. 7B, the cavity 672 may be configured to receivebone growth material therein.

Embodiments herein are also directed to methods of installing theexpandable spinal implant 600. These methods can include providing theexpandable spinal implant 600 in the collapsed configuration, forexample, as illustrated in FIG. 7A. When in the collapsed configuration,the medial ends 652, 660 of the first and second arms 608, 610 may bepivoted towards the elongate body 602.

In some embodiments, the step of providing the expandable spinal implant600 in the collapsed configuration can include inserting the implant 600into a selected location, such as a cavity between two vertebral bodiescreated by a discectomy or other procedure. In some embodiments, thisstep can include reversibly coupling the implant 600 to an insertiontool, and using the insertion tool to guide the implant 600 into thecavity. For example, in some embodiments, the insertion tool maythreadably engage the receptacle 615 on the second end 614 of theimplant 600. The implant 600 can be inserted into the cavity using avariety of approaches, such as anteriorly, posteriorly,transforaminally, or laterally. In some embodiments, the implant 600 mayadvantageously be configured to be inserted into an intervertebral spaceusing a lateral procedure. Those skilled in the art may appreciate that,in some embodiments, when in the closed or collapsed configuration, theexpandable spinal implant 600 may have a width that is about 50-65% lessthan the width in the expanded configuration. In some embodiments, theclosed or collapsed width of the implant 600 may be about 55-60% lessthan the expanded width. In other embodiments, the closed or collapsedwidth of the implant 600 may be less than half of the expanded widththereof. Advantageously, the implant 600 may be inserted through asmaller, less-invasive opening that may result in reduced trauma tomuscles, nerves, or other tissue. When used in a lateral procedure(e.g., lateral lumbar interbody fusion), the implant 600 may be insertedlaterally in the far anterior side of the intervertebral space. Thistechnique can advantageously reduce or minimize interaction with theposteriorly-located lumbar plexus.

Methods of installing the implant 600 can also include translating thelateral ends 650, 658 of the first and second arms 608, 610 medially(e.g., towards the center of the implant 600 and/or away from the firstand second ends 612, 614). In some embodiments, this step can includetranslating the translatable connector 606 towards the second end 614 ofthe elongate body 602. Those skilled in the art may appreciate that asthe connector 606 translates towards the second end 614, the first arm608 may also be translated towards the second end 614, e.g., along thegroove 626. The medial end 652 may also be urged away from the elongatebody 602 as the first arm 608 pivots about the post disposed within theslot 648, as illustrated in FIG. 7B. As the medial end 652 of the firstarm 608 is urged away from the elongate body 602, the medial end 652 mayalso urge the medial end 660 of the second arm 610 away from theelongate body 602. The second arm 610 may simultaneously travel mediallyand pivot within the grooves 622, 624 away (e.g., posteriorly) from theelongate body 602. The lateral ends 650, 658 of the first and secondarms 608, 610 may be translated medially and/or the medial ends 652, 660may be pivoted away from the elongate body 602 until the implant 600attains an expanded width that is greater than the collapsed width. Insome embodiments, the first and/or second arms 608, 620 are translatedand/or pivoted until one or both are in contact with the apophyseal ringof a vertebra, as illustrated in FIG. 7C.

In some embodiments, the step of translating the lateral ends 650, 658medially and simultaneously pivoting the medial ends 652, 660 away fromthe elongate body 602 may include actuating (e.g., rotating) theactuator 604. As the actuator 604 rotates, the threaded section mayengage the threads on the translatable connector 606, urging thetranslatable connector 606 to translate along the actuator 604 towardsthe leading and/or trailing ends 603, 605 of the implant 600. In someembodiments, the actuator 604 may be actuated by a driver, such as anexpansion driver. The driver may include a drive member configured tomate with the tool-engaging surface 636. For example, the driver mayinclude a hexagonal, star, Phillips, and/or slotted drive member. Insome embodiments, at least a portion of the driver may be insertedthrough the insertion tool, into the passageway 630, and into engagementwith the actuator 604. Torque applied to the driver may then betransferred to the implant 600 through the actuator 604 as describedherein.

In some embodiments, the method can further include locking or securingthe expandable implant 600 in the expanded configuration. In otherembodiments, the expandable implant 600 may be self-locking. Forexample, the threaded engagement between the actuator 604 and thetranslatable connector 606 may advantageously inhibit inadvertentlateral movement of the translatable connector 606.

Some methods can further include disengaging the insertion tool and/ordriver from the implant 600. This step can include disengaging thedriver from the actuator 604, for example, by retracting the driver awayfrom the tool-engaging surface 636. This step can also includeunthreading the insertion tool from the threaded receptacle 615. Methodsherein can also include inserting bone graft material into the cavity672. In some embodiments, this step may be accomplished before theinsertion tool and/or driver is disengaged from the implant 600. Inthese embodiments, the insertion tool and/or driver may include acannula through which the bone graft material may be transported to theimplant 600, for example, via the passageway 628. In other embodiments,the bone graft material may be inserted after the insertion tool and/ordriver is removed. In these embodiments, the bone graft material may beinserted, e.g., directly through the passageway 628 and/or through agraft window on the elongate body 602.

Turning now to FIGS. 8A-D, some embodiments herein are directed to anexpandable spinal implant 800 that can include an elongate body 802, afirst (e.g., leading) arm 804, and a second (e.g., trailing) arm 806.The expandable spinal implant 800 may include a length defined between aleading end 803 and a trailing end 805. The expandable implant 800 mayalso include a width defined from anterior side surface 808 of theelongate body 802 to a lateral end of the first and/or second arms 804,806. The expandable spinal implant 800 may advantageously be configuredto transition reversibly between an expanded configuration and acollapsed configuration. The implant 800 may have a width in theexpandable configuration that is greater than a width in the collapsedconfiguration. In some embodiments, the implant 800 may have a collapsedwidth in the range of from about 10 mm to about 15 mm, and an expandedwidth in the range of from about 25 mm to about 30 mm.

As illustrated in FIG. 8B, the elongate body 802 can include a first(e.g., leading) end 810 and a second (e.g., trailing) end 812. Theelongate body 802 may have a length as measured between the first end810 and the second end 812. The second end 812 may be configured toengage an insertion tool. The second end 812 may include a receptacle(not shown) configured to engage the insertion tool. As illustrated inFIG. 8C, the elongate body 802 may include an upper wall 816, a lowerwall 818 opposite the upper wall, a posterior side surface 822, and ananterior side surface 808. Those skilled in the art may appreciate thatthese and other directional terms herein are used for descriptivepurposes and do not limit the orientation in which any of the expandablespinal implants described herein may be used. The elongate body 802 mayhave a width as measured between the anterior side surface 808 and theposterior side surface 822. In some embodiments, the width of theelongate body 802 may be generally equal to the width of the implant 800in the collapsed configuration. In some embodiments, the elongate body802 may include a cutout (not shown) that passes through the upper wall816, lower wall 818, and/or posterior side surface 822. The may define aposterior opening along the posterior side surface 822. In someembodiments, the anterior side surface 808 may be convex, as viewed, forexample, from the upper wall 816 and/or lower wall 818. The upper and/orlower walls 816, 818 may extend between the first end 810 and the secondend 812. The elongate body 802 may be at least partially hollow. Theupper wall 816 may include a superior (e.g., outer) and/or inferior(e.g., inner) surface. The lower wall 818 may also include a superior(e.g., inner) surface and/or an inferior (e.g., outer) surface. Asdescribed herein, the outer surfaces of the upper and/or lower walls816, 818 may include a plurality of texturizing members. In someembodiments, the outer surfaces of the upper and/or lower walls 816, 818may be convex, as viewed from the anterior side surface 808, posteriorside surface 822, leading end 810, and/or trailing end 812. In otherembodiments, the outer surfaces of the upper and/or lower walls 816, 818may be angled and/or slanted, such that the height of the elongate body802 is greater at the anterior side surface 808 than at the posteriorside surface 822. In these embodiments, the expandable spinal implant800 may be wedge-shaped. In other embodiments, the expandable spinalimplant 800 may have a constant height.

In some embodiments, the elongate body 802 may be tapered at the leadingend 810. For example, the leading end 810 can include a tapered height(e.g., as measured between the outer surfaces of the upper wall 816 andthe lower wall 818) and/or a tapered width (e.g., as measured betweenthe anterior side surface 808 and the posterior side surface 822). Inuse, the tapered leading end 810 may advantageously be configured todistract tissue during insertion.

The inferior surface of the upper wall 816 and/or the superior surfaceof the lower wall 818 can include one or more guide members (e.g., agroove, channel, rail, slot, track, and/or rack). In some embodiments,the guide member may include teeth, e.g., gear teeth and/or ratcheting.In some embodiments, the guide member(s) on the upper wall 816 may beparallel and/or symmetrical to the guide member(s) on the lower wall818. The guide member(s) may include straight and/or curved sections.The guide member(s) may extend generally along a portion of the lengthof the elongate body 802. The guide member(s) may have a first endcloser to the leading end 810 and a second end closer to the trailingend 812. Additionally, one end may be oriented anteriorly or posteriorlyto the other end. In some embodiments, one or more guide members can belocated at the leading and/or trailing ends 810, 812. For example, theinferior surface of the upper wall 816 can include at least one guidemember at the leading end 810 and at least one guide member at thetrailing end 812. The superior surface of the lower wall 818 may alsoinclude at least one guide member at the leading end 810 and at leastone guide member at the trailing end 812. In some embodiments, the guidemember at the leading end and the guide member at the trailing end maybe symmetrical. In some embodiments, the inferior surface of the upperwall 816 can include a first groove (not shown) at the leading end 810and a second groove 824 at the trailing end 812, as illustrated in FIG.8D. The groove 824 can include a first (e.g., medial) end 864 and asecond (e.g., lateral) end 866. The medial end 864 may be posterior tothe lateral end 866.

In some embodiments, the elongate body 802 may have a generally constantwidth. In other embodiments, the width of the trailing end 812 may begenerally equal to the width of the leading end 810. The elongate body802 may include a passageway 826 extending at least partially along alength thereof. The passageway 826 may also include an opening 828 atthe trailing end 812 of the elongate body 802, as illustrated in FIG.8C. The passageway 826 may be configured to receive a tool, such as adriver, therethrough. In some embodiments, the passageway 826 mayinclude a locking member, such as a pin, configured to restrain the tooltherein. In some embodiments, the passageway 826 may be cylindrical(e.g., may include a constant, circular diameter). The passageway 826may pass between (e.g., may not intersect) the upper and lower walls816, 818. In some embodiments, the passageway 826 may intersect one ormore additional passageways of the implant 800. For example, inembodiments where the elongate body 802 includes a cutout as describedherein, the passageway 826 may be in fluid communication with thecutout. In some embodiments, the first and/or second arms 804, 806 maybe accessible through the passageway 826. The trailing end 812, or otherportion of the elongate body 802, may also include one or more windowsconfigured to receive bone growth material therethrough.

The second arm 806 may be pivotably, translationally, and/or slideablycoupled to the elongate body 802, for example, at the second end 812. Asillustrated in FIG. 8D, the second arm 806 may include a lateral end 838and a medial end 840. The second arm 806 may also include a superiorsurface 842 and an inferior surface (not shown) opposite of the superiorsurface 842. In some embodiments, the second arm 806 may be a unitarybody. In other embodiments, the second arm 806 may include multiplepieces or segments. In some embodiments, the medial end 840 may beconfigured to be coupled with the second collar, described furtherherein. For example, the medial end 840 may include a rounded throughhole 844 configured to receive a pin 846 associated and/or integratedwith the second collar therethrough.

The medial end 840 of the second arm 806 may be coupled to the elongatebody 802. In some embodiments, the second arm 806 may include at leastone protrusion (e.g., bump, tab, and/or gear member) on a superiorand/or inferior surface thereof. For example, the second arm 806 mayinclude protrusion 848 on the superior surface 842 at the medial end 840thereof. The protrusion may be configured to engage and/or mate with oneof the guide members on the elongate body 802. As illustrated in FIG.8D, the protrusion 848 may be configured to be received within thegroove 824 at the second end 812 of the elongate body 802. The secondarm 806 may include another protrusion on the inferior surface at themedial end 840 thereof. This protrusion may be configured to be receivedwithin a groove on the superior (e.g., inner) surface of the lower wall818 of the elongate body 802. In use, those skilled in the art mayappreciate that the protrusion 848 (alone or in combination with one ormore protrusions on the inferior surface) may guide the second arm 806along the path defined by the groove 824, and may enable the second arm806 to pivot relative thereto, as illustrated in FIG. 8D. Additionally,those skilled in the art may appreciate that in other embodiments, theelongate body 802 may include one or more protrusions and the firstand/or second arms 804, 806 may include one or more guide members. Thesecond arm 806 may include a curved or angled anterior (e.g., outer)and/or posterior (e.g., inner) surface. The second arm 806 may have aheight that is not greater than the height of the elongate body 802.When the implant 800 is in the collapsed configuration, the second arm806 may be configured to not protrude beyond the anterior and/orposterior side surfaces 808, 822 of the elongate body 802, asillustrated in FIG. 8A.

The first arm 804 may be pivotably, translationally, and/or slideablycoupled to the elongate body 802, for example, at the first end 810. Asillustrated in FIG. 8A, the first arm 804 may include a lateral end 832and a medial end 834. The first arm 804 may also include a superiorsurface 836 and an inferior surface (not shown) opposite the superiorsurface 836. In some embodiments, the first arm 804 may be a unitarybody. In other embodiments, the first arm 804 may include multiplepieces or segments. In some embodiments, the medial end 834 may beconfigured to be coupled with the first collar, described furtherherein. For example, the medial end 834 may include a rounded throughhole configured to receive a pin associated and/or integrated with thefirst collar therethrough.

The medial end 834 of the first arm 804 may be coupled to the elongatebody 802. In some embodiments, the first arm 804 may include at leastone protrusion (e.g., bump, tab, and/or gear member) on a superiorand/or inferior surface thereof. For example, the first arm 804 mayinclude a protrusion on the superior surface 836 at the medial end 834thereof. The protrusion may be configured to engage and/or mate with oneof the guide members on the elongate body 802. The protrusion may beconfigured to be received within a groove at the first end 810 of theelongate body 802. The first arm 804 may include another protrusion onthe inferior surface at the medial end 834 thereof. This protrusion maybe configured to be received within a groove on the superior (e.g.,inner) surface of the lower wall 818 of the elongate body 802. In use,those skilled in the art may appreciate that the protrusion (alone or incombination with one or more protrusions on the inferior surface) mayguide the first arm 804 along the path defined by the groove, and mayenable the first arm 804 to pivot relative thereto. Additionally, thoseskilled in the art may appreciate that in other embodiments, theelongate body 802 may include one or more protrusions and the firstand/or second arms 804, 806 may include one or more guide members. Thefirst arm 804 may include a curved or angled anterior (e.g., outer)and/or posterior (e.g., inner) surface. The first arm 804 may have aheight that is not greater than the height of the elongate body 802.When the implant 800 is in the collapsed configuration, the first arm804 may be configured to not protrude beyond the anterior and/orposterior side surfaces 808, 822 of the elongate body 802, asillustrated in FIG. 8A.

In some embodiments, the expandable spinal implant 800 may furtherinclude a first collar 850 and/or a second collar 852, as illustrated inFIG. 8A. In some embodiments, the first collar 850 may include a distalend disposed within the passageway 826 and a proximal end configured toengage the first arm 804. The distal end may include a threaded holeextending therethrough and configured to be coaxial with the passageway826. The proximal end may include a pin configured to be received withina through hole on the first arm 804, as described herein with respect tosecond arm 806. In other embodiments, the proximal end may include athrough hole configured to be coaxial with the through hole on the firstarm 804, and a separate pin may couple the first collar 850 and thefirst arm 804. In some embodiments, the first arm 804 may be inpivotable engagement with the first collar 850. The second collar 852may include some or all of the same features as the first collar 850. Asillustrated in FIG. 8A, the second collar 852 may be configured toengage the second arm 806 (e.g., at the medial end 840 thereof).

As illustrated in FIG. 8A, the implant 800 may also include an elongaterod 830. The elongate rod 830 may be configured to be housed and/ordisposed within the passageway 826 of the elongate body 802, forexample, as illustrated in FIG. 8A. The elongate rod 830 may beconfigured to rotate within the passageway 826 about longitudinal axis858, illustrated in FIG. 8C. The elongate rod 830 may include a leadingend 854 and a trailing end 856, as illustrated in FIG. 8C. The trailingend 856 may include a tool-engaging surface configured to engage adriver. For example, the trailing end 856 may include a socketconfigured to couple with a driver, such as a hexagonal, star, Phillips,and/or slotted driver. As illustrated in FIG. 8A, the elongate rod 830may include a first threaded section 860 and a second threaded section862 between the leading and trailing ends 854, 856. The threads of thefirst section 860 may extend in a direction opposite the threads of thesecond section 862 (e.g., clockwise and counterclockwise, or viceversa). The first threaded section 860 may be configured to engage thefirst collar 850 and the second threaded section may be configured toengage the second collar 852. In some embodiments, the elongate body 802may include at least one retention member, such as a pin or keyed hole,which may be configured to inhibit translation of the elongate rod 830within the passageway 826. In some embodiments, the elongate rod 830 mayinclude a receptacle, such as a circumferential groove or undercut, thatmay be configured to receive or engage the retention member.

Embodiments herein are also directed to methods of installing theexpandable spinal implant 800. These methods can include providing theexpandable spinal implant 800 in the collapsed configuration, forexample, as illustrated in FIG. 8A. When in the collapsed configuration,the lateral ends 832, 838 of the first and second arms 804, 806 may bepivoted towards the elongate body 602. Accordingly, the first and secondarms 804, 806 may be generally parallel to the elongate body 602.

In some embodiments, the step of providing the expandable spinal implant800 in the collapsed configuration can include inserting the implant 800into a selected location, such as a cavity between two vertebral bodiescreated by a discectomy or other procedure. In some embodiments, thisstep can include reversibly coupling the implant 800 to an insertiontool, and using the insertion tool to guide the implant 800 into thecavity. The implant 800 can be inserted into the cavity using a varietyof approaches, such as anteriorly, posteriorly, transforaminally, orlaterally. In some embodiments, the implant 800 may advantageously beconfigured to be inserted into an intervertebral space using a lateralprocedure. Those skilled in the art may appreciate that, in someembodiments, when in the closed or collapsed configuration, theexpandable spinal implant 800 may have a width that is about 50-65% lessthan the width in the expanded configuration. In some embodiments, theclosed or collapsed width of the implant 800 may be about 55-60% lessthan the expanded width. In other embodiments, the closed or collapsedwidth of the implant 800 may be less than half of the expanded widththereof. Advantageously, the implant 800 may be inserted through asmaller, less-invasive opening that may result in reduced trauma tomuscles, nerves, or other tissue. When used in a lateral procedure(e.g., lateral lumbar interbody fusion), the implant 800 may be insertedlaterally in the far anterior side of the intervertebral space. Thistechnique can advantageously reduce or minimize interaction with theposteriorly-located lumbar plexus.

Methods of installing the implant 800 can also include translating thelateral ends 832, 838 of the first and second arms 804, 806 laterallyand/or posteriorly (e.g., away from the center of the implant 800). Insome embodiments, this step can include translating the first collar 850towards the first end 810 of the elongate body 802 and translating thesecond collar 852 towards the second end 812. Those skilled in the artmay appreciate that as the second collar 852 translates towards thesecond end 812, the second arm 806 may also be translated towards thesecond end 812, e.g., along the groove 824. The lateral end 838 may alsobe urged away from the elongate body 802 as the second arm 806 pivotsabout the pin 846, as illustrated in FIG. 8D. As the lateral end 838 ofthe second arm 806 is urged away from the elongate body 802, the lateralend 832 of the first arm 804 may similarly be urged away from theelongate body 802 by the first collar 850. For example, the first arm804 may simultaneously travel laterally and pivot away (e.g.,posteriorly) from the elongate body 802.

In embodiments where the expandable spinal implant 800 includes theelongate rod 830, the step of simultaneously translating and pivotingthe lateral ends 832, 838 laterally and away from the elongate body 802can include rotating the elongate rod 830. As the elongate rod 830rotates, the first collar 850 may translate along the elongate rod 830in a first direction, e.g., towards the leading end 810 of the elongatebody 802. Additionally, the second collar 852 may translate along theelongate rod 830 in a second direction, e.g., towards the trailing end812 of the elongate body 802. The first collar 850 may urge the firstarm 804 to translate in the first direction and the second collar 852may urge the second arm 806 to translate in the second direction. As thefirst arm 804 translates towards the leading end 810, one of the guidemembers (e.g., a groove or track) may guide the lateral end 832 of thefirst arm 804 to pivot away from the elongate body 802 (e.g.,posteriorly). Similarly, as the second arm 806 translates towards thetrailing end 812, the protrusion 848 may travel along the groove 824 ofthe elongate body 802, e.g., from the medial end 864 to the lateral end866. The path defined by the groove 824 may guide the lateral end 838 ofthe second arm 806 away from the elongate body 802 (e.g., posteriorly),as illustrated in FIG. 8D. In some embodiments, the path defined by theelongate rod 830 and the first and second collars 850, 852, and the pathdefined by the guide members, may influence the paths taken by the firstand second arms 804, 806. Those skilled in the art may appreciate thatthe first and second arms 806 may each be configured to rotate or pivotrelative to the respective collars and guide members with which they maybe engaged. The elongate rod 830 may be rotated, urging the lateral ends832, 838 of the first and second arms 804, 806 away from the elongatebody 802, until the implant 800 attains a second, expanded width that isgreater than the closed or collapsed width, as illustrated in FIG. 8B.In some embodiments, the first and/or second arms 804, 806 may betranslated and/or pivoted until one or both are in contact with theapophyseal ring of a vertebra. As illustrated in FIG. 8B, as the firstand second arms 804, 806 translate laterally and/or posteriorly, theymay define a cavity 868 therebetween.

In some embodiments, the elongate rod 830 can be rotated and/or actuatedby a driver, such as an expansion driver. The driver may be part of theinsertion tool. The driver may include a drive member configured to matewith a tool-engaging surface at the trailing end 856 of the elongate rod830. For example, the driver may include a hexagonal, star, Phillips,and/or slotted drive member. In some embodiments, the driver may engagethe elongate rod 830 by inserting the drive member (e.g., a hex key)into a socket at the trailing end 856 of the elongate rod 830. Torquemay then be applied to the driver, thereby rotating the elongate rod830.

In other embodiments, the expandable spinal implant 800 may not includeelongate rod 830. In these embodiments, the implant 800 can be expandedusing a driver (not shown). The driver can include an elongate rodassembly that can include a leading end, a trailing end, a firstthreaded section between the leading and trailing ends, and a secondthreaded section between the leading and trailing ends. In someembodiments, he threads of the first section can extend in a directionopposite the threads of the second section (e.g., clockwise andcounterclockwise, or vice versa). In other embodiments, they can extendin the same direction. Methods of installing the expandable spinalimplant 800 can include providing the implant in the collapsedconfiguration as described herein and inserting the driver into thepassageway 826. The methods can also include coupling the first threadedsection of the elongate rod assembly with the first collar 850 andcoupling the second threaded section of the elongate rod assembly withthe second collar 852. The driver can also be coupled to the elongatebody 802, for example, to inhibit longitudinal translation of thedriver. The methods can also include rotating the elongate rod assembly,thereby translating the first collar 850 in a first direction and thesecond collar 852 in a second, opposite direction, and consequentlyurging the lateral ends 832, 838 of the first and second arms 804, 806laterally and/or posteriorly until the implant 800 attains an expandedwidth that is greater than the collapsed width.

In some embodiments, the elongate rod assembly can include a first rodmember concentrically disposed within a cannula of a second rod member.The first threaded section may be disposed on the first rod member andthe second threaded section may be disposed on the second rod member.The first rod member may be configured to extend and retract from withinthe second rod member. The first and second rod members may beconfigured to rotate independently of each other. In these embodiments,the step of rotating the elongate rod assembly can include rotating thefirst rod member to translate the first collar 850 in a first direction(e.g., towards the leading end 803) and rotating the second rod memberto translate the second collar 852 in a second direction (e.g., towardsthe trailing end 805).

In some embodiments, the method can further include locking or securingthe expandable implant 800 in the expanded configuration. This step caninclude threading a set screw into the implant 800 to block or preventthe first and/or second arms 804, 806 from retracting to their collapsedpositions. In other embodiments, one or more components of the implant800 may include a retention member, such as a ratchet or angled tooth,which may be configured to prevent the first and/or second arms 804, 806from retracting. In yet other embodiments, the implant 800 may beself-locking. For example, the threaded engagement between the elongaterod 830 and the first and second collars 850, 852 may advantageouslyinhibit inadvertent lateral movement of the first and second collars850, 852.

Some methods herein can further include disengaging the insertion tooland/or driver from the implant 800. In embodiments that include theelongate rod 830, this step can include disengaging the driver from theelongate rod 830 (e.g., retracting the driver from the trailing end856). In embodiments that do not include the elongate rod 830, this stepcan include disengaging (e.g., unthreading) the driver from the firstand second collars 850, 852. This step can also include disengaging theinsertion tool from the receptacle at the second end 812. Methods hereincan also include inserting bone graft material into the cavity 868. Insome embodiments, this step may be accomplished before the insertiontool and/or driver is disengaged from the implant 800. In theseembodiments, the insertion tool and/or driver may include a cannulathrough which the bone graft material may be transported to the implant800, for example, via the passageway 826. In other embodiments, the bonegraft material may be inserted after the insertion tool and/or driver isremoved. In these embodiments, the bone graft material may be inserted,e.g., through the passageway 826 and/or through a graft window on theelongate body 802.

In some embodiments, one or more of the expandable spinal implantsdiscussed above can be used with graft material inserted therein as partof a fusion procedure. In addition, the expandable spinal implants canbe used with other implants as part of a system, including stabilizingrods, screws (e.g., pedicle screws), hooks, and other fusion devices. Insome embodiments, the expandable spinal implants can be used inconjunction with prosthetic devices, such as an artificial disc. Forexample, an expandable spinal implant can be used on one spinal level,while a prosthetic implant can used on a different spinal level.

The invention being thus described, it will be obvious that the same maybe varied in many ways. Such variations are not to be regarded as adeparture from the spirit and scope of the invention, and all suchmodifications as would be obvious to one skilled in the art are intendedto be included within the scope of the following claims. Althoughindividual embodiments are discussed herein, the invention covers allcombinations of all those embodiments.

1-20. (canceled)
 21. A laterally expanding intervertebral spacercomprising: a body having a leading end, a trailing end, an upper walladapted to contact a lower surface of a vertebral body and a lower walladapted to contact an upper surface of an adjacent vertebral body; afirst arm having a first end pivotally and translatably coupled to thebody and a second end; a second arm having a first end pivotally andtranslatably coupled to the body and a second end; an actuator forlaterally extending the second ends of the first and second arm.
 22. Thespacer of claim 21, wherein the second ends of the first and second armsare pivotally coupled to each other such that extension of the secondend of the first arm by the actuator simultaneously causes extension ofthe second end of the second arm.
 23. The spacer of claim 21, furthercomprising a translating connector coupled between the actuator and thefirst arm, and adapted to translate relative to the actuator.
 24. Thespacer of claim 23, wherein the body includes an elongate recess and thefirst arm has a protrusion received in the elongate recess for rotationand translation relative to the body when the translating connectortranslates relative to the actuator.
 25. The spacer of claim 23,wherein: the actuator includes an external threading; the translatingconnector includes an external thread section in mesh with the externalthreading of the actuator such that rotation of the actuator causestranslation of the translating connector.
 26. The spacer of claim 23,wherein the translating connector includes a vertical slot and the firstarm includes a post received in the vertical slot of the translatingconnector.
 27. The spacer of claim 21, wherein the body includes aninternal passage and one end of the actuator includes a tool engagingsurface to receive a driver through the internal passage for actuatingthe actuator.
 28. The spacer of claim 21, wherein body includes firstand second grooves and the second arm has first and second protrusionsrespectively received in the first and second grooves.
 29. The spacer ofclaim 28, wherein a distance between the first and second recessesdecreases in the direction away from the trailing end and toward theleading end.
 30. The spacer of claim 21, wherein actuator has acircumferential groove, further comprising a pair of pins disposed inthe circumferential recess to prevent translation of the actuator.
 31. Alaterally expanding intervertebral spacer comprising: An elongate bodyhaving a trailing end and a leading end and a cutout therebetween; afirst arm having a first end pivotally and translatably coupled to thebody and a second end; a second arm having a first end pivotally andtranslatably coupled to the body and a second end pivotally coupled tothe second of the first arm; wherein the second ends of the first andsecond arm are disposed in the cutout in a contracted state; an actuatorfor laterally extending the second ends of the first and second arm inan expanded state, wherein the first and second arms laterally expand byrotation and translation of both the first and second arms.
 32. Thespacer of claim 31, wherein the second ends of the first and second armsare pivotally coupled to each other through a pivotal pin received inrespective holes of the first and second arms.
 33. The spacer of claim31, further comprising a translating connector coupled between theactuator and the first arm, and adapted to translate relative to theactuator.
 34. The spacer of claim 33, wherein the body includes anelongate recess and the first arm has a protrusion received in theelongate recess for rotation and translation relative to the body whenthe translating connector translates relative to the actuator.
 35. Thespacer of claim 33, wherein: the actuator includes an externalthreading; the translating connector includes an external thread sectionin mesh with the external threading of the actuator such that rotationof the actuator causes translation of the translating connector.
 36. Thespacer of claim 33, wherein the translating connector includes avertical slot and the first arm includes a post received in the verticalslot of the translating connector.
 37. The spacer of claim 31, whereinthe body includes an internal passage and one end of the actuatorincludes a tool engaging surface to receive a driver through theinternal passage for actuating the actuator.
 38. The spacer of claim 31,wherein body includes first and second grooves and the second arm hasfirst and second protrusions respectively received in the first andsecond grooves.
 39. The spacer of claim 38, wherein a distance betweenthe first and second recesses decreases in the direction away from thetrailing end and toward the leading end.
 40. The spacer of claim 31,wherein actuator has a circumferential groove, further comprising a pairof pins disposed in the circumferential recess to prevent translation ofthe actuator.